AP/HP Pôle 7

- Urgences Pédiatrique (Centre d'Urgences Diagnostic Rapide - CUDR) -

Réponses affichées : 74

Lien PubMed [Zuclopenthixol benzoate poisoning in a child: Evidence from chromatography]
MENAGER C, BOIMOND N, CHERON G
2013 - Arch Pediatr 20(3):286-8
Zuclopenthixol is a thioxanthene-based neuroleptic. It may cause acute intoxication in children with neurological and consciousness disorders. Immunochromatography is unable to identify the molecule and diagnosis requires mass spectroscopy and HP chromatography. The short time needed for this technique significantly improves the exploration and treatment of Clopixol poisoning.
Unité(s) : Réanimation Pédiatrique & Néonatologie, CUDR
 
Lien PubMed Pachymeningitis after meningococcal infection
TOUBIANA J, HEILBRONNER C, GITIAUX C, OUALHA M, TAHA MK, ROUSSEAU C, PICARD C, MIRA JP, GENDREL D
2013 - Lancet 381(9877):1596
Unité(s) : Pédiatrie Générale, Neurologie, CUDR, CEDI
 
Lien PubMed Randomized Trial of Oral Versus Sequential IV/Oral Antibiotic for Acute Pyelonephritis in Children
BOCQUET N, SERGENT-ALAOUI A, JAIS JP, GAJDOS V, GUIGONIS V, LACOUR B, CHERON G
2012 - Pediatrics 129(2):e269-75
OBJECTIVE:To confirm whether oral antibiotic treatment is as efficacious as sequential intravenous/oral antibiotic treatment in the prevention of renal scarring in children with acute pyelonephritis and scintigraphy-documented acute lesions.METHODS:In a prospective multicenter trial, children aged 1 to 36 months with their first case of acute pyelonephritis, a serum procalcitonin concentration >/=0.5 ng/mL, no known uropathy, and a normal ultrasound exam were randomized into 2 treatment groups. They received either oral cefixime for 10 days or intravenous ceftriaxone for 4 days followed by oral cefixime for 6 days. Patients with acute renal lesions detected on early dimercaptosuccinic acid scintigraphy underwent a follow-up scintigraphy 6 to 8 months later.RESULTS:The study included 171 infants and children. There were no significant differences between the 2 groups in any clinical characteristic. Initial scintigraphy results were abnormal for 119 children. Ninety-six children were measured for renal scarring at the follow-up scintigraphy (per protocol analysis population). The incidence of renal scarring was 30.8% in the oral treatment group and 27.3% for children who received the sequential treatment.CONCLUSIONS:Although this trial does not statistically demonstrate the noninferiority of oral treatment compared with the sequential treatment, our study confirmed the results of previously published reports and therefore supports the use of an oral antibiotic treatment of primary episodes of acute pyelonephritis in infants and young children.
Unité(s) : Biochimie Générale, Biostatistique, CUDR
 
Lien PubMed Do parents understand the medical information provided in paediatric emergency departments? A prospective multicenter study
CHAPPUY H, TAUPIN P, DIMET J, CLAESSENS YE, TRELUYER JM, CHERON G
2012 - Acta Paediatr 101(10):1089-1094
Aim: We evaluated the extent to which parents understood the medical information about hospitalization of their child in an emergency department and looked for characteristics likely to increase the risk of poor comprehension. Methods: Prospective multicenter study in thirteen paediatric emergency departments. The parents and doctors completed questionnaires based on closed-ended questions with a common core of four items: reasons of hospitalization, diagnosis, treatment and seriousness of child condition. We evaluated concordance between parents and doctor answers for these items by comparing their responses. Results: This study included 380 parents. Percentage of concordance was 55% for the reason of hospitalization, 78% for the diagnosis, 92% for the treatment, 48% for the seriousness of the condition and 19% for all four items. The mean number of concordant items was 2.76 (CI 95%, 2.66-2.86). Parents whose children seemed not in pain and parents who received additional information from the nurse showed significantly slightly higher levels of concordance with doctor's answers (2.98 vs 2.66, p = 0.006 and 2.89 vs 2.60, p = 0.004, respectively). Conclusion: This study shows that improvements are required in the clarity of the information delivered to the parents. The assistance of nurses and optimal pain management may help to improve communication.
Unité(s) : Biostatistique, CUDR, EA 3620, CIC 0901
 
Lien PubMed [Sedation and analgesia in emergency structure. Paediatry: Which sedation and analgesia for the child under spontaneous ventilation?]
CHERON G
2012 - Ann Fr Anesth Reanim 31(4):369-76
Unité(s) : CUDR
 
Lien PubMed [Unusual presentation of rib malformation]
COSSON MA, BRETON S, APRAHAMIAN A, GREVENT D, CHERON G
2012 - Arch Pediatr 19(11):1208-11
Rib malformation and anatomical variations are not well known and are still often underdiagnosed. Usually, rib malformations are fortuitously discovered. We describe here the case of a girl, 4years and 4months old, who presented at the emergency unit for fever and an anterior tumefaction of the ribcage, without any other symptoms. She was eupneic with a normal pulmonary auscultation and viral tonsillitis with a negative streptococcus test. The thoracic tumefaction was parasternal, painless, and fixed and measured approximately 2.5x2cm. Ultrasound findings consisted of a duplicated and hypoechogenic hypertrophy of the sterno-costal cartilage of the 4th left rib. Magnetic resonance imaging (MRI) confirmed the diagnosis of chondral bifidity of the sterno-costal junction of the 4th left rib. Fever, due to the viral tonsillitis, disappeared after 4days. Rib malformations are rare, often anterior, unilateral, and preferentially located on the 3rd or the 4th rib. The main malformative rib lesions are bifid ribs, rib spurs, and widened ribs. Very rarely, they can be associated with Gorlin-Goltz syndrome or with other malformations such as VATER complex. The main differential diagnoses of these rib malformations are traumatic, tumoral, and infectious etiologies. In case of tumoral diseases, the topography of the lesion focuses the etiologic diagnosis: whereas an anterior and cartilaginous lesion is always benign, a lateral or posterior lesion can be an Ewing sarcoma. Rib malformation investigation consists in meticulous questioning, a complete clinical examination looking for any associated anomaly, completed by basic imaging explorations such as plain thoracic radiography focused on the ribcage and ultrasound. Finally, complementary computerized tomography or preferably MRI, depending on the anatomic location of the lesion, confirms the final diagnosis, as presented in our case report, and removes any uncertainty.
Unité(s) : CUDR, Radiologie Pédiatrique
 
Lien PubMed ABC drug transporter and nuclear receptor expression in human cytotrophoblasts: Influence of spontaneous syncytialization and induction by glucocorticoids
MANCEAU S, GIRAUD C, DECLEVES X, SCHERRMANN JM, ARTIGUEBIEILLE F, GOFFINET F, CHAPPUY H, VINOT C, TRELUYER JM
2012 - Placenta 33(11):927-32
OBJECTIVES: ABC transporters in the human placenta play a major role in protecting the fetus against potential toxic drugs. The glucocorticoid dexamethasone has been shown to induce ABCB1 expression in enterocytes and hepatocytes. However, in placental cells, little data exists either for dexamethasone, betamethasone or prednisone while these three glucocorticoids may be used during pregnancy. We investigated the modulation of placental ABC transporter and nuclear receptor expression by these drugs. METHODS: Cytotrophoblasts were isolated from normal full-term placentas. We first assessed the influence of spontaneous syncytialization on transporter and nuclear receptor gene expression by taking samples of cytotrophoblasts after 24, 48 and 72 h of cell culture (n = 7 placentas). Incubations were then conducted with dexamethasone (50 nM-1 muM), betamethasone (20-400 nM) and prednisone (50 nM-1 muM) versus no drug for 24 h (n = 6). mRNA expression was determined by qRT-PCR. RESULTS: Influence of syncytialization was observed only for ABCB1, ABCC2 and ABCC5 gene expression between t = 24 and 48 h (p < 0.05). Therefore, the following induction studies were conducted between t = 48 h and 72 h. Dexamethasone and betamethasone significantly induced ABCB1 gene expression by around 4-fold (p < 0.01 and 0.001, respectively). In parallel, 100 nM betamethasone decreased the glucocorticoid receptor gene expression by 22% (p < 0.01). Prednisone showed no effect on transporter or receptor expression. CONCLUSIONS: These results suggest that dexamethasone or betamethasone administration may decrease the maternal-fetal transfer of an associated treatment being ABCB1 substrate, which may be either protective or deleterious for the fetus depending on the treatment's therapeutic aim.
Unité(s) : CUDR, EA 3620, CIC 0901
 
Lien PubMed [Neonatal exposure to active pulmonary tuberculosis in a maternity ward: screening and clinical course of a cohort of exposed infants]
PERRY A, ANGOULVANT F, CHADELAT K, DE LAUZANNE A, HOUDOUIN V, KHENICHE A, LORROT M, MESPLES B, NOUYRIGAT V, AUJARD Y, GAUDELUS J, GRIMPREL E, FAYE A
2012 - Arch Pediatr 19(4):396-403
Few data are available on the impact of a tuberculosis exposure on newborns in a maternity ward. OBJECTIVES: To describe the screening and clinical course of infants exposed during the neonatal period to a caregiver with bacillary tuberculosis. PATIENTS AND METHODS: Infants exposed during the postnatal period in a maternity unit in Paris, from March to August 2005, to a caregiver with bacillary tuberculosis were included in a standardized screening protocol. The screening performed at baseline (M0) and at 3 months (M3) included a clinical evaluation, a tuberculin skin test (TST), and a chest X-ray. A preventive treatment for tuberculosis with isoniazid and rifampicin for 3 months was systematically proposed. RESULTS: At M0, 182 of the 217 infants (84%) with significant exposure were evaluated. Data were available for 172 infants. The median age at M0 was 4.9 months (IQR=3.8-6.2). At M0, 4 of 172 infants (2.3%) had latent TB infection. Between M0 and M3, 19 infants (11%) were lost to follow-up and 1 on 153 developed a latent TB infection. No cases of tuberculosis disease were diagnosed. The treatment was administered properly in 83% of cases and side effects were observed in 11% of infants without any serious adverse event. Four infants received no treatment and 11 stopped their treatment prematurely. CONCLUSION: In the absence of neonatal massive exposure, although low (2.9%), the risk of latent TB infection requires close monitoring of the infants exposed. However, in the context of a mild exposure in the maternity unit, surveillance without systematic initiation of TB preventive treatment could be discussed.
Unité(s) : CUDR
 
Lien PubMed [Boxing-related cranial injury in children: A case report]
TIMSIT S, ROUGEAU T, GREVENT D, CHERON G
2012 - Arch Pediatr 19(11):1187-90
No pediatric recommendations exist in France on the exercise of boxing by children and adolescents despite the risk of traumatic injury, sometimes serious. We report the case of a 15-year-old boy who participated in amateur boxing and had a subdural hematoma. Brain injuries and concussions are frequent and multiple. Severity is not always correlated with the intensity of the blows. There are age-related features. Several international medical organizations oppose boxing for children and adolescents.
Unité(s) : CUDR, Neurochirurgie Pédiatrique, Radiologie Pédiatrique
 
Lien PubMed [Minoxidil intoxication, the pharmacological agent of a hair lotion.]
APRAHAMIAN A, ESCODA S, PATTEAU G, MERCKX A, CHERON G
2011 - Arch Pediatr 18(12):1297-99
Accidental intoxications in children are frequent but most of them are without serious consequences. We describe herein the case of a young girl who drank 100mg of a topical hair lotion with minoxidil. On arrival, she had no symptoms except flush on the face and ears. Four and half hours after ingestion, tachycardia appeared with a pulse above 170 beats per min with hypotension at 76/24mmHg. The heart rate remained between 170 and 190 beats per min for 12h and then lowered to between 140 and 160 beats per min. Thirty-six hours after ingestion, the heart beat was at 140 beats per min. Minoxidil is a strong vasodilator used first in the 1970s for severe hypertension. It produces hypotension by direct arteriolar vasodilatation. Only a few cases of minoxidil intoxication have been described in the literature, including only one pediatric case. This young boy had only tachycardia of 160 beats per min for 40h. Most serious cases have been described in adults. They suffered long-lasting tachycardia, hypotension, and ECG changes. Most patients need a bolus of normal saline fluid and some with hemodynamic problems need vasoactive drugs such as dopamine and/or phenylephrine. All patients need to be under medical supervision for a long time because of the product's very long action.
Unité(s) : CUDR
 
Lien PubMed [Acute abdominal pain in children. Emergencies and conducting diagnostic]
CHERON G
2011 - Rev Prat 61(5):615-6
Unité(s) : CUDR
 
Lien PubMed The European Paediatric Life Support course improves assessment and care of dehydrated children in the emergency department
CHERON G, JAIS JP, COJOCARU B, PAREZ N, BIARENT D
2011 - Eur J Pediatr 170(9):1151-7
We tested the hypothesis that application of the principles learned from the European Paediatric Life Support (EPLS) course improves child health assessment and care. In a retrospective study, residents from five paediatric emergency departments were included. For each of them, we analysed five medical records of infants and children suffering from diarrhoea; three were in ambulatory care and two were in-hospital care with IV hydration. Two independent observers analysed the records using a standardized checklist of 14 clinical points, as well as three items to evaluate the adequacy of treatment according to hydration status. Agreement between readers was evaluated the kappa coefficient of concordance. Statistical associations between each item and the EPLS course status was assessed by logistic regression taking into account the clustered data structure. Fifty residents and 240 medical records were included. Twenty-six residents were EPLS trained (intervention group) and 24 residents were not (control group). The results of the analyses of the medical records by the observers were concordant (kappa >0.91). Medical records in the intervention group contained more clinical information on circulatory status (P < 0.0001). Residents in the intervention group prescribed goal-directed therapy more often (P = 0.006). For children with shock, they administered volume resuscitation (P = 0.01) with goal-directed therapy more often (P = 0.003). This is the first evaluation of an educational program focusing on the actions of "learners" in the clinical environment. Our findings highlight that the EPLS course is associated with a better clinical analysis of hydration and circulation status as well as with goal-directed therapy.
Unité(s) : Biostatistique, CUDR
 
Lien PubMed [Clinical features and outcome of 2009 H1N1 influenza in the pediatric setting. Multicenter prospective study in the ED.]
DESMOULINS C, MICHARD-LENOIR AP, NAUD J, CLAUDET I, NOUYRIGAT V, CHERON G
2011 - Arch Pediatr 18(5):505-11
STUDY OBJECTIVE: The clinical manifestations and outcome of infants and children with confirmed 2009 H1N1 influenza in emergency departments is described. METHODS: We conducted a prospective multicenter case series involving children with symptoms of influenza-like illness in whom 2009 H1N1 influenza was diagnosed on reverse-transcriptase polymerase chain reaction assay on a nasopharyngeal swab or nasal aspirates and who were admitted to the ED of four university pediatric hospitals. The following data were collected: age, gender, preexisting chronic conditions (PECs) associated with a high risk for influenza-related complications, clinical symptoms, outcome, antiviral treatment, and complications. We recorded length of cough and fever during a phone-call on day 8. RESULTS: Between 1st October and 31st December 2009, 466 children were included. Their median age was 4 years (range, 1 day to 17years). The median time to consultation was 24h. Of these 466 infants and children, 55 were aged less than three months and 153 had one or more PECs. Asthma was the most frequent condition. Children at risk and children without risk did not differ for complications (28% vs 31%, P>0.05). Respiratory complications (17%) and decompensations of preexisting disease were the most frequent. Infants aged less than three months did not have more complications than infants without PECs. At-risk infants and children were more frequently hospitalized (P<0.02) and the duration of the pediatric ward stay was longer (P<0.02). This was true only for children aged less than three months. Of the hospitalized children, 17 (9%) were admitted to an ICU. Duration of fever (3.8days) and duration of cough (6.3days) did not differ according to whether or not children received oseltamivir. CONCLUSION: Infants younger than three months of age are not a group at risk for influenza-related complications. Oseltamivir did not reduce duration of symptoms in this population.
Unité(s) : CUDR
 
Lien PubMed Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis
LEHERT P, CHERON G, CALATAYUD GA, CEZARD JP, CASTRELLON PG, GARCIA JM, SANTOS M, SAVITHA MR
2011 - Dig Liver Dis 43(9):707-13
BACKGROUND: Racecadotril is an antidiarrhoeal drug with intestinal antisecretory mechanism of action. AIM: To assess racecadotril efficacy as an adjunct to oral rehydration solution, against oral rehydration solution alone or with placebo in childhood acute gastroenteritis. METHODS: Individual patient data meta-analysis following multilevel mixed models testing the significance of the treatment effect adjusted for baseline covariates. RESULTS: Nine randomised clinical trials (n=1384) were identified with raw data. Baseline dehydration level and Rotavirus were found as two essential predictors influencing the outcomes. The proportion of recovered patients was higher in racecadotril groups compared with placebo, Hazard Ratio HR=2.04, 95% CI (1.85; 2.32), p<0.001. For inpatient studies, the ratio of mean stool output racecadotril/placebo was 0.59 (0.51; 0.74), p<0.001. For outpatient studies, the ratio of the mean number of diarrhoeic stools racecadotril/placebo was 0.63 (0.51; 0.74), p<0.001. CONCLUSION: Dehydration level and Rotavirus at baseline are essential adjustments to compare treatments. As an adjunct to oral rehydration solution, racecadotril has a clinically relevant effect in reducing diarrhoea (duration, stool output and stool number), irrespective of baseline conditions (dehydration, Rotavirus or age), treatment conditions (inpatient or outpatient studies) or cultural environment.
Unité(s) : CUDR
 
Lien PubMed [Neurological complications revealing infectious endocarditis: 2 case reports.]
NOUYRIGAT V, PATTEAU G, BAJOLLE F, ANTHOINE-MILHOMMES MC, CHAPPUY H, CHERON G
2011 - Arch Pediatr 18(4):401-04
Neurological signs are reported in less than 20% of infectious endocarditis (IE) cases. The most frequent complications include cerebral infarction, intracerebral hemorrhage, meningitis, and mycotic aneurysm. We describe two patients, one with congenital heart disease and the other with normal heart, who presented neurological manifestations and fever leading to an IE diagnosis. Neurological complications may be the first symptom of infectious endocarditis and are a major factor associated with increased morbidity and mortality. Early diagnosis and early treatment will minimize cardiac and neurological morbidities.
Unité(s) : Cardiologie Pédiatrique, CUDR
 
Lien PubMed [About recommendations and experience in emergency paediatric anaesthesia : reply.]
ORLIAGUET G, DIEPENDAELE JF, CHERON G, VIVIEN B, DE LA COUSSAYE JE
2011 - Ann Fr Anesth Reanim 30(5):444-45
Unité(s) : CUDR, Médecine d'Urgence, Réanimation Pédiatrique & Néonatologie
 
Lien PubMed Comparison of a morphine and midazolam combination with morphine alone for paediatric displaced fractures: a randomized study
WILLE-LEDON C, CHAPPUY H, GIRAUD C, TRELUYER JM, CHERON G
2011 - Acta Paediatr 100(11):e203-7
Aim: To compare the efficacy of sublingual midazolam with oral morphine versus that of oral morphine with placebo in a paediatric population attending an emergency department (ED) with acute long-bone fractures. Methods: A sample of children aged 5-16 years with clinically deformed closed long-bone fractures was randomized to groups receiving either oral morphine (0.5 mg/kg)/sublingual placebo or oral morphine (0.5 mg/kg)/sublingual midazolam (0.2 mg/kg). The main exclusion criteria were narcotic or benzodiazepine use, significant head injury, multiple organ failure, femoral fracture and allergy. Pain scores were rated on a 100-mm visual analogue scale (VAS) at 0, 15, 30, 60, 90 and 120 min. Results: Fifty-eight children were enrolled (mean age: 10.5 years, SD 2.7). Fractures concerned the radius or ulna in 43 cases (74.1%), the humerus (22.4%) and the tibia or fibula (3.5%). No significant difference in VAS scores was observed between the two treatment arms (p = 0.72). Drowsiness was significantly more frequent in the midazolam group (p = 0.007) during the first 2 h after administration. No serious adverse event was observed. Conclusion: The analgesic performances of morphine and the combination of morphine with midazolam assessed by VAS were similar in children presenting at the ED with a long-bone fracture.
Unité(s) : CUDR, EA 3620, URC
 
Lien PubMed Bleeding complications after ritual circumcision: about six children
BOCQUET N, CHAPPUY H, LORTAT-JACOB S, CHERON G
2010 - Eur J Pediatr 169(3):359-62
Circumcision is the most common surgical procedure in boys. Even if the procedure is frequent, circumcision can have tragic complications. We report the cases of six children, seen over 1 year at the emergency department for bleeding complication or mutilation after ritual home circumcision. To avoid such complications, it is recommended that circumcision should be performed by doctors trained in this procedure. Parents have to be cautioned about the risks of possible complications after this procedure.
Unité(s) : CUDR
 
Lien PubMed Length of the treatment and number of doses per day as major determinants of child adherence to acute treatment
CHAPPUY H, TRELUYER JM, FAESCH S, GIRAUD C, CHERON G
2010 - Acta Paediatr 99(3):433-37
Abstract Objective: To determine the rate of aftercare adherence to prescriptions from a paediatric emergency department and to identify predictors for nonadherence. Methods: Patients discharged from a French paediatric emergency department with at least one oral drug prescription were included. A telephone interview questionnaire was used to determine whether the child had received the treatments according to the prescription. Adherence was assessed according to three items: frequency of drug administration, length of treatment and drug administering method. Complete adherence was defined as adherence to the three items mentioned above, and nonadherent as nonadherent to at least one of the items. Influence of age, sex, pathology, language spoken at home, type of medical insurance, type of medication prescribed, diagnosis, dissatisfaction with the explanation of the medical problem, number of prescribed medications, length of the treatment and number of doses per day was assessed. Results: One hundred and five telephone interviews were exploited. The children were 60 boys (57%) and 45 girls (43%). The ages of these 105 children were between 0.2 and 12 years. The most common diagnoses were asthma and pulmonary infection. Complete adherence with the prescription was 36.2%. Three factors were significantly associated with nonadherence (p < 0.05): length of treatment, number of doses per day and male sex. Conclusion: This study suggests that simplifying treatment schedules is an effective strategy for improving compliance in paediatric emergency departments.
Unité(s) : CUDR
 
Lien PubMed An unusual cause of extensive edema
ESCODA S, CHAPPUY H, CHERON G
2010 - Pediatr Emerg Care 26(5):378-9
Edema of nutritional origin is quite rare in industrialized countries. We report the case of an 8-month-old boy with a history of kwashiorkor. Even if the diagnosis is not obvious, there is a need to perform a proper diagnosis at admission to avoid inappropriate management.
Unité(s) : CUDR
 
Lien PubMed Influence of development, HIV infection, and antiretroviral therapies on the gene expression profiles of ABC transporters in human lymphocytes
GIRAUD C, MANCEAU S, DECLEVES X, GOFFINET F, MORINI JP, CHAPPUY H, BATTEUX F, CHOUZENOUX S, YOUSIF S, SCHERRMANN JM, BLANCHE S, TRELUYER JM
2010 - J Clin Pharmacol 50(2):226-30
The efficacy of drugs acting on lymphocytes like anticancer, immunosuppressive, and antiretroviral drugs depends on their intracellular concentrations, which could be modulated by membrane efflux pumps belonging to the ABC transporter superfamily. The gene expression profiles of 6 main ABC transporters (MDR1, MRP1, MRP3, MRP4, MRP5, and BCRP) were established in lymphocytes from birth to adulthood using blood samples from 57 children and 15 adults (34 and 5 HIV-infected, respectively). Gene expression levels were quantified by quantitative RT-PCR. In adults, the MRP1 gene had the highest expression, followed by the MRP5 gene. BCRP and MRP4 genes were significantly higher expressed at birth than after 1 month of life. Neither HIV infection nor antiretroviral therapies modulated the gene expression profiles of ABC transporters. In conclusion, drugs that are substrates of BCRP and MRP4, like zidovudine, may have an altered efficacy in newborns.
Unité(s) : CUDR, Immunologie-Hématologie Pédiatriques, EA 3620
 
Lien PubMed VIP hypersecretion as primary or secondary syndrome in neuroblastoma: A retrospective study by the Societe Francaise des Cancers de l'Enfant (SFCE)
BOURDEAUT F, DE CARLI E, TIMSIT S, COZE C, CHASTAGNER P, SARNACKI S, DELATTRE O, PEUCHMAUR M, RUBIE H, MICHON J
2009 - Pediatr Blood Cancer 52(5):585-90
BACKGROUND: Neuroblastic tumors (NTs) are occasionally associated with watery diarrhea, due to Vasoactive Intestinal Peptide (VIP) secretion. Most reports are single cases and suggest a great homogeny within this sub-group of NTs. PROCEDURES: We conducted a retrospective analysis of the French experience of NTs associated with watery diarrhea due to VIP-secretion. VIP secretion was confirmed by seric dosage and/or immunohistochemistry. RESULTS: Twenty-two patients met the diagnostic criteria between 1988 and 2007. Most of patients suffered from weight loss and metabolic disorders. In 16 cases, digestive symptoms preceded the diagnosis of the tumor ("Primary VIP secreting NTs"); 15 were localized and all showed a differentiated histology. Interestingly, in another 6 patients with high-risk NT, diarrhea occurred at the time of chemotherapy or retinoic acid therapy ("Secondary VIP secreting NTs"). Differentiation in response to treatment was documented in 4 cases. In all cases, only surgical excision of the tumor was able to control the digestive symptoms. Twenty children are alive and 13 are disease-free. CONCLUSION: VIP secreting NTs are usually associated with differentiation; they can also secondarily arise from a high-risk tumor upon treatment. Primary surgery constitutes first-line treatment.
Unité(s) : Chirurgie Viscérale Pédiatrique, CUDR
 
Lien PubMed [Medications dosage and adherence.]
CHAPPUY H, PATTEAU G, TRELUYER JM, CHERON G
2009 - Arch Pediatr 16(6):968-9
Unité(s) : CIC, CUDR
 
Lien PubMed [Intensive care course for pediatricians in the emergency department.]
CHERON G, ESCODA S, PATTEAU G, COJOCARU B
2009 - Arch Pediatr 16(6):899-900
Unité(s) : CUDR
 
Lien PubMed [Clinical practice guidelines in the Pediatric Emergency Department.]
CHERON G, PATTEAU G, CHAPPUY H, NOUYRIGAT V
2009 - Arch Pediatr 16(6):748-9
Unité(s) : CUDR
 
  Neurological consequences of vitamin B12 deficiency and its treatment
CHALOUHI C, FAESCH S, ANTHOINE-MILHOMME MC, FULLA Y, DULAC O, CHERON G
2008 - Pediatr. Emerg. Care 24(8):538-541
In developed countries, the vitamin B12 deficiency usually occurs in children exclusively breast-fed, whose mothers are vegetarians, causing low stores of vitamin B12. Symptoms of vitamin B12 deficiency appear during the second trimester of life and include failure to thrive, lethargy, hypotonia, and arrest or regression of developmental skills. A megaloblastic anemia can be present. One half of the infants exhibit abnormal movements before the start of treatment with intramuscular cobalamin, which disappear 1 or 2 days after. More rarely, movement disorders appear a few days after treatment, whereas neurological symptoms are improving. These abnormal movements can last for 2 to 6 weeks. If not treated, vitamin B12 deficiency can cause lasting neurodisability. Therefore, efforts should be directed to preventing deficiency in pregnant and breast-feeding women on vegan diets and their infants by giving them vitamin B12 supplements. When preventive supplementation has failed, one should recognize and treat quickly an infant presenting with failure to thrive and delayed development.
Unité(s) : CUDR, Neurologie
 
  Children's views on their involvement in clinical research
CHAPPUY H, DOZ F, BLANCHE S, GENTET JC, TRELUYER JM
2008 - Pediatr. Blood Cancer 50(5):1043-1046
OBJECTIVE: To examine the level of children's understanding of informed consent in clinical trials and factors that may influence these processes. DESIGN: Twenty nine children who were included in clinical trials for treatment of cancer or HIV, were offered the possibility to complete a semidirective interview, with parental permission. METHODS: Children's understanding was measured by a score of 0-9 including items required to obtain a valid consent according to French and European legislations. RESULTS: Children were 8.5-18 years old (13.6 +/- 2.8 years). The higher percentage of understanding was obtained for the study objectives (n = 18, 62%), the risks (n = 17, 58%), the potential self-benefits (n = 18, 62%) and the potential benefits to other children (n = 17, 58%). The lower percentage of understanding was obtained for the procedures (n = 5, 17%), the possibility of alternative treatments (n = 9, 31%), the duration of participation (n = 6, 21%), their right to withdraw (n = 6, 21%), and the voluntary participation (n = 6, 21%). Sixteen children (55%) thought that the given information was adequate. Understanding was significantly correlated with child's age (r = 0.65; P = 0.0001) and the mean score was higher in patients over 14 years old compared to patients under the age of 14 (4.4 +/- 2.4, n = 14 vs. 2.6 +/- 2.6, n = 15, P < 0.05). The mean score was also higher in children when informed consent was sought some time after the diagnosis (>7 days) rather than at the same time (<7 days) (score: 4.14 +/- 2.59 n = 21 vs. 1.87 +/- 2.03 n = 8; P = 0.03). The clarity of information perceived by children did not influence their understanding (score: 3.6 +/- 2.6 n = 14 vs. 3.5 +/- 2.7 n = 15; P = 0.91). CONCLUSION: Children have an incomplete understanding of the elements included in the informed consent forms. Understanding is related to age and timing of informed consent. Pediatr Blood Cancer 2008;50:1043-1046. (c) 2007 Wiley-Liss, Inc.
Unité(s) : CUDR, Immuno-Hématologie-Rhumatologie Pédiatriques, EA3620
 
  Acute acalculous cholecystitis in a child returning from the Ivory Coast
ANTHOINE-MILHOMME MC, CHAPPUY H, CHERON G
2007 - Pediatr. Emerg. Care 23(4):242-243
Acute cholecystitis is an uncommon occurrence in children. Acute acalculous cholecystitis (AAC) has various etiology; among them are a wide variety of infectious agents. We report the case of a 7-year-old child who presented AAC due to plasmodium falciparum infection. The causes of AAC are discussed.
Unité(s) : CUDR
 
  Sedation in the emergency department: how far can and should we go ?
CHERON G, BRISSAUD O, WILLE C, CHAPPUY H
2007 - Archives Pédiatrie 14(6):732-734
Unité(s) : CUDR
 
  Pharmacokinetic modelling of the placental transfer of nelfinavir and its M8 metabolite: a population study using 75 maternal-cord plasma samples
HIRT D, URIEN S, JULLIEN V, FIRTION G, CHAPPUY H, REY E, PONS G, MANDELBROT L, TRELUYER JM
2007 - Br. J. Clin. Pharmacol. 64(5):634-644
AIMS: A population pharmacokinetic model was developed to characterize the transfer of nelfinavir and its active metabolite M8 from maternal to cord plasma and amniotic fluid. METHODS: Concentration data were obtained from 75 women on the day of delivery and for whom maternal, umbilical plasma and amniotic fluid samples were collected. Data from 53 pregnant, 61 nonpregnant and seven consecutively pregnant and non pregnant women were then added to the database, the contents of which were analyzed using NONMEM. RESULTS: Nelfinavir and M8 concentrations in maternal plasma, umbilical plasma and amniotic fluid were described by six connected compartments. Mean (% intersubject variability) population estimates were: absorption rate 00.67 h(-1), lag time 00.87 h, oral clearance and volume of distribution: 39.5 l h(-1) (53%), and 557 l for non pregnant and pregnant women, respectively, and 115 l h(-1) (132%) and 1626 l, respectively, on the day of delivery, M8 formation clearance 0.77 l h(-1) and M8 elimination rate constant 03.41 h(-1) (74%). For nelfinavir and M8, respectively, the mother-to-cord parameters were 0.058 l h(-1) (34%), and 00.35 h(-1) (76%), the cord-to-amniotic fluid rate constants were 0.23 and 00.59 h(-1), and the elimination rate constants from amniotic fluid were 0.36 and 00.49 h(-1). The nelfinavir fetus : maternal concentration ratio was 25% for maternal concentrations between 0.1 and 2.5 mg l(-1), between the 31 and 41st week of gestation. CONCLUSIONS: The low transfer of nelfinavir from the placenta is unlikely to protect the fetus from vertical HIV-1 transmission.
Unité(s) : CUDR, U663
 
  Metered-dose inhaler with spacer versus nebulization for severe and potentially severe acute asthma treatment in the pediatric emergency department
SANNIER N, TIRNSIT S, COJOCARU B, LEIS A, WILLE C, GAREL D, BOCQUET N, CHÉRON G
2007 - Rev. Fr. Allergol. Immunol. Clin. 47(2):64-71
Objective.- To compare treatment with beta 2 agonist delivered either by a spacer device or a nebulizer in children with severe or potentially severe acute asthma. Methods.- In this randomized trial, children 4 to 15 years, cared for in the emergency department for severe or potentially severe acute asthma, received 6 times either nebulizations of salbutamol (0.15 mg/kg) or puffs of a beta 2 agonist (salbutamol 50 mu g/kg or terbutaline 125 mu g/kg). The primary outcome was the hospitalization rate. Secondary outcomes included percentage improvement in Bishop score, in PEF, SaO(2), respiratory and heart rates, side effects, length of stay and relapses 10 and 30 days later. Results.- Groups did not differ for baseline data. There were no significant differences between the 2 groups (nebulizer N = 40, spacer N = 39) for baseline characteristics before emergency department consultation except for length of acute asthma in the spacer group. Clinical evolution after treatment, hospitalization rate, relapse were similar including the more severe subgroup. In the spacer group, tachycardia was less frequent (P < 0.02). The overall length of stay in the emergency department was significantly shorter (148 +/- 20 vs 108 +/- 13 min, P < 10(-9)). Conclusions.- The administration of beta 2 agonist using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with severe or potentially severe acute asthma in the emergency department. Time gained can be used for asthma education. (C) 2007 Publie par Elsevier Masson SAS.
Unité(s) : CUDR
 
  Delay in diagnosis of imported Plasmodium falciparum malaria in children
CHALUMEAU M, HOLVOET L, CHERON G, MINODIER P, FOIX-L'HELIAS L, OVETCHKINE P, MOULIN F, NOUYRIGAT V, BREART G, GENDREL D
2006 - Eur. J. Clin. Microbiol. Infect. Dis. 25(3):186-189
The study reported here prospectively evaluated the time-to-diagnosis of imported Plasmodium falciparum malaria in children in seven French pediatric emergency departments during a 1-week period. For the 29 patients included, the mean patient, doctor and total delays were 3.1, 1.5 and 4.7 days, respectively. The late medical diagnosis for 11 patients was mainly due to the treating physician's failure to consider malaria, despite having been informed that the child had been in an endemic area, and erroneously making a diagnosis of viral infection. The five patients who were diagnosed correctly without delay had higher mean platelet counts than the others (206,000 vs 118,541/mm(3); p=0.008). The results indicate that greater awareness of the risk of malaria in returning travelers may help reduce delays in diagnosis and its consequences.
Unité(s) : CUDR
 
  Abdominal pain in children. Traps and diagnosis
CHERON G, FAESCH S, CHALOUHI C
2006 - Archives Pédiatrie 13(6):814-816
Unité(s) : CUDR
 
  Impact of CRP rapid test in management of febrile children in paediatric emergency units of Ile-de-France
COHEN R, ROMAIN O, LEVY C, PERREAUX F, DECOBERT M, HAU I, LECUYER A, LESPRIT E, MAMAN L, ROULLAUD S, CHERON G, BEKRI A, D'ATHIS P, HENRIQUET V, DE LA ROCQUE F
2006 - Archives Pédiatrie 13(12):1566-1571
OBJECTIVE: Fever is a common cause of children visits to emergency units. Clinical evaluation does not always eliminate a bacterial infection. Among blood markers, several publications showed the interest of CRP. This study was undertaken to evaluate correlation between two techniques of CRP, one by usual technique at the laboratory and the other by a rapid test, and to evaluate the impact of this rapid test for febrile children at the emergency room, when a hospitalization was not immediately decided. MATERIAL AND METHODS: The study was undertaken in 2004-2005 in eight emergency paediatric units in Ile-de-France concerning febrile children during two periods. In period A, children had at the same time a CRP dosage through two methods, whereas in period B, only a rapid CRP test was first managed. The test used was NycoCard CRP Single test (Progen Biotechnique). RESULTS: Between September 2004 and June 2005, 572 children were included, 268 in period A and 304 in period B. Comparison of CRP results by the two methods showed for 247 children (93%) a fairly good linear correlation (r: 0.929). Blood cell count was the most often prescribed test (99.4 vs 10.5%). Conversely to chest radiography, blood culture, fibrinogen and urinary test were significantly most frequent in period A. The average cost of the additional examinations was 2.6 times more important during the first period. Duration of children management in the units was approximately two times shorter when rapid CRP test was used (199.7+/-92.8 vs 103.5+/-98.6 min). CONCLUSION: This study shows the interest of rapid CRP test for febrile children in the emergency units, and has to be confirmed in ambulatory paediatric practice.
Unité(s) : CUDR
 
  Prospective comparison of child asthma education in the emergency department and at scheduled follow-up consultation
COJOCARU B, DE BLIC J, SCHEINMANN P, CHERON G
2006 - Archives Pédiatrie 13(8):1112-1117
OBJECTIVES: To assess asthma control in asthmatic children attending the emergency department and to compare it with that for children with scheduled specialist follow-up. POPULATION AND METHODS: Between September 2002 and September 2003, we included asthmatic children aged 6 to 16 years, attending the emergency department (group U) or pulmonology follow-up appointments (group C) at Necker Hospital, Paris, France. We used the Asthma Therapy Assessment Questionnaire (ATAQ), completed by the parents and children aged 10 years and over. RESULTS: We interviewed 156 families and included 144 (92%) in the final analysis (77 in group U). The 2 groups did not differ in age, sex ratio, age at onset and asthma diagnosis and the frequency of asthma attacks. Children in group U received less daily maintenance treatment (P<0.01) but reported more severe asthma (P<0.05). They had also experienced fewer investigations for their asthma (fewer lung function tests P=0.01 and allergy tests P=0.001). The children in group C had better controlled asthma, as assessed by both the children themselves and their parents. They also had fewer problems relating to the behavior, communication and treatment control domains. The assessment of children and parents were similar in all areas except communication. The children considered their communication problems to be more serious than their parents did. Age-related differences were observed, with older children's parents having more difficulties in all domains investigated. CONCLUSION: Clinicians should consider assessing asthma control in children attending the emergency department. There is clearly an opportunity to improve the quality of asthma education for these children. Clinicians could provide children with a written plan of action for asthma attacks and information about daily self-management. Improving communication between children, their parents and doctors should be considered a key educational project.
Unité(s) : CUDR, Pneumologie-Allergologie Pédiatrique
 
  Management of intussusception in France in 2004: investigation of the Paediatric Infectious Diseases Group, the French Group of Paediatric Emergency and Reanimation, and the French Society of Paediatric Surgery
GRIMPREL E, DE LA ROCQUE F, ROMAIN O, MINODIER P, DOMMERGUES MA, LAPORTE-TURPIN E, LORROT M, PAREZ N, CAULIN E, ROBERT M, LEHORS H, CHERON G, LEVY C, HAAS H
2006 - Archives Pédiatrie 13(12):1581-1588
OBJECTIVES: To describe the different pathways of management of intussusception (IS) in infants and children in metropolitan France and to identify paediatric emergency centres that might constitute a surveillance network for IS. MATERIAL AND METHODS: A questionnaire was sent to 273 paediatric emergency centres distributed across France in 2005. Modalities of diagnosis and treatment of IS had to be precised. RESULTS: One hundred and sixty-seven centres (61.2%) responded. The response was given by 131 paediatricians (78.4%) and 36 surgeons (21.6%) working in 38 universitary hospitals (22.7%) and 129 general hospitals (77.2%). The mean number of IS treated in each centre in 2004 was 11+/-13.5 (extr. 0 to 70; median 6). Diagnosis of IS required a collaboration between medical and surgical teams in 51.5% of the centres, but in 40.1% the sole medical team was in charge of the diagnosis. Ultrasonography is used for diagnosis by 98.8% of the centres. Reduction with hydrostatic enema and eventually surgery was performed in the same hospital in 44.3%. Other centres systematically or frequently transferred the patients for reduction, mostly towards universitary hospitals (90%). CONCLUSION: The procedures of IS diagnosis are the same everywhere in France but the pathways of therapeutic management do vary, depending on the availability of surgeons and anaesthetists trained in paediatrics on each site. These disparities will probably change with the implementation of the new plan for sanitary organization in children and adolescents in France. Labellized paediatric emergency centres will gather more surgical patients and could eventually constitute an effective surveillance network for IS.
Unité(s) : CUDR
 
  Pregnancy-related effects on nelfinavir-M8 pharmacokinetics: a population study with 133 women
HIRT D, TRELUYER JM, JULLIEN V, FIRTION G, CHAPPUY H, REY E, PONS G, MANDELBROT L, URIEN S
2006 - Antimicrob. Agents Chemother. 50(6):2079-2086
A relationship between nelfinavir antiretroviral efficacy and plasma concentrations has been previously established. As physiological changes associated with pregnancy have a large impact on the pharmacokinetics of many drugs, a nelfinavir population study with women was developed, and the large intersubject variability was analyzed in order to optimize individual treatment schedules for this drug during pregnancy. A population pharmacokinetic model was developed in order to describe the concentration time course of nelfinavir and its metabolite M8 in pregnant and nonpregnant women. Individual characteristics, such as age, body weight, and weeks of gestation or delivery, which may influence nelfinavir-M8 pharmacokinetics were investigated. Data from therapeutic drug monitoring in 133 women treated with nelfinavir were retrospectively analyzed with NONMEM. Nelfinavir pharmacokinetics was described by a one-compartment model with linear absorption and elimination and M8 produced from the nelfinavir central compartment. Mean pharmacokinetic estimates and the corresponding intersubject percent variabilities for a nonpregnant woman were the following: absorption rate, 0.83 h(-1); absorption lag time, 0.85 h; apparent nelfinavir elimination clearance (CL(10)/F), 35.5 liters/h (50%); apparent volume of distribution (V/F), 596 liters (118%); apparent formation clearance to M8 (CL(1M)/F), 0.65 liters/h (69%); and M8 elimination rate constant (k(M0)), 3.3 h(-1) (59%). During pregnancy, we observed significant increases in nelfinavir (44.4 liters/h) and M8 (5 h(-1)) elimination but unchanged nelfinavir transformation clearance to M8, suggesting an induction of CYP3A4 but no effect on CYP2C19. Apparent nelfinavir clearance and volume showed a twofold increase on the day of delivery, suggesting a decrease in bioavailability on this day. The M8 elimination rate was increased by concomitant administration of nonnucleoside reverse transcriptase inhibitors. A trough nelfinavir plasma concentration above 1 mg/liter was previously shown to improve the antiretroviral response. The Bayesian individual pharmacokinetic estimates suggested that the dosage should not be changed in pregnant women but may be doubled on the day of delivery.
Unité(s) : CUDR
 
  Metered-dose inhaler with spacer vs nebulization for severe and potentially severe acute asthma treatment in the pediatric emergency department
SANNIER N, TIMSIT S, COJOCARU B, LEIS A, WILLE C, GAREL D, BOCQUET N, CHERON G
2006 - Archives Pédiatrie 13(3):238-244
Objective. - To compare treatment with beta 2 agonist delivered either by a spacer device or a nebulizer in children with severe or potentially severe acute asthma. Methods. - In this randomized trial, children 4 to 15 years, cared for in the emergency department for severe or potentially severe acute asthma, received 6 times either nebulizations of salbutamol (0.15mg/kg) or puffs of a beta 2 agonist (salbutamol 50 mug/kg or terbutaline 125 mug/kg). The primary outcome was the hospitalization rate. Secondary outcomes included percentage improvement in Bishop score, in PEF, SaO(2), respiratory and heart rates, side effects, length of stay and relapses 10 and 30 days later. Results. - Groups did not differ for baseline data. There were no significant differences between the 2 groups (nebulizer N=40, spacer N=39) for baseline characteristics before emergency department consultation except for length of acute asthma in the spacer group. Clinical evolution after treatment, hospitalization rate, relapse were similar including the more severe subgroup. In the spacer group, tachycardia was less frequent (P<0.02). The overall length of stay in the emergency department was significantly shorter (148+/-20 vs 108+/-13 min, P<10(-9)). Conclusions. - The administration of beta 2 agonist using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with severe or potentially severe acute asthma in the emergency department. Time gained can be used for asthma education.
Unité(s) : CUDR
 
  Hématémèse chez un enfant de 11 mois : un mode de révélation rare d'un corps étranger intragastrique
BOCQUET N, GUILLOT L, MOUGENOT JF, RUEMMELE FM, CHERON G
2005 - Archives Pédiatrie 12(4):424-426
Ingestion of foreign body has often no consequence. We report on a case in an 11-month-old girl who was referred for mild hematemesis and anorexia. Upper digestive tract endoscopy found a small metallic foreign body in the gastric antrum. After its removal, all symptoms disappeared. It is usually recommended to remove foreign bodies by endoscopy when they are in esophageal position, or are more than 3 to 5 cm long, or have a shape that may hurt the gut mucosa. Although rare, a gastric foreign body should be searched for in face of an upper gastrointestinal bleeding in an infant.
Unité(s) : CUDR, Gastroentérologie Pédiatrique
 
  Informed consent in pediatric clinical trials
CHAPPUY H, GARY A, CHERON G, TRELUYER JM
2005 - Archives Pédiatrie 12(6):778-780
Unité(s) : CUDR
 
  Compliance with medication in children
CHAPPUY H, TRELUYER JM, GARY A, PONS G, CHERON G
2005 - Archives Pédiatrie 12(6):921-923
Unité(s) : CUDR
 
  Réponse de l'auteur. Analgésie aux urgences pédiatriques
CHERON G
2005 - Archives Pédiatrie 12(2):212-213
Unité(s) : CUDR
 
  Treatment of exacerbation of asthma: what are today's issues?
PLOIN D, ROUSSON A, VITOUX-BROT C, NOUYRIGAT V, FOUCAUD P, LEMAIRE JP, CHEVALLIER B, BERGERON S, MARTINOT A, CHERON G, FLORET D
2005 - Archives Pédiatrie 12(3):351-356
During past decades, major progress has been accomplished in the management of acute asthma. Most recent recommendations include evidence-based rationale. The improved quality of clinical guidelines makes them efficient models for medical education. The pediatric pharmacopoeia provides a great variety of choices of drugs as well as for asthma medical devices. These innovations dramatically facilitated the medical management of asthmatic children, but they did not solve all problems. Physicians now use higher doses of salbutamol, but the early prescription of systemic glucocorticoids for moderate exacerbation of asthma is still underused, given the most recent clinical guidelines and meta-analysis. Furthermore, repeated emergency department visits to the wards and lack of primary care physician should systematically be appraised when evaluating severity, as they are both major risk factors for severe exacerbations, even though they are not considered in acute asthma severity scores. Finally, initiating (or reinforcing) patient education at the time of exacerbation also presents important challenges, as emergency visits are a favorable moment to commence the therapeutic education of the child and his family. Indeed, framing the controller medications and educating families about how to manage the disease and to improve their domestic environment are the genuine tools available for the prevention of asthma exacerbations, and particularly those most severe.
Unité(s) : CUDR
 
  Infections bactÈriennes ostÈoarticulaires du nourrisson et de l'enfant : expÈrience sur un an
TIMSIT S, PANNIER S, GLORION C, CHERON G
2005 - Archives Pédiatrie 12(1):16-22
Unité(s) : CUDR, Traumatologie et Orthopédie Pédiatriques
 
  Utilisation de la morphine orale pour les douleurs post-traumatiques de l'enfant
WILLE C, BOCQUET N, COJOCARU B, LEIS A, CHERON G
2005 - Archives Pédiatrie 12(3):248-253
Objectives. - To study the compliance of prescription, the efficacity and the adverse events of oral morphine used in the pediatric emergency departement (ED) in traumatic pains. Method. - This prospective study was conducted in the ED from october 2002 to september 2003. Children aged six months to 16 years with a visual analogic scale (VAS) score higher than 70 or with a traumatic member deformation received oral morphine (0,5 mg/kg). Pain was assessed every 30 minutes using two scales: behavioral observation by the faces scale and objective pain scale (OPS) for children less than five years, behavioral observation by the faces scale and self-report by VAS for children older than five years. The compliance of prescription, the pain scores and the adverse events were studied. Results. - Ninety-one children received oral morphine and seventy-four children were studied. Seventy per cent of prescriptions were in accordance with the recommandations. For patients younger than five years a rapid decrease of pain was observed in thirty minutes. The pain's reduction was respectively 79 and 84% with faces scale and OPS when they left ED. For children older than five years, pain's reduction was more important and more rapid when pain assessment was made by nurses than when it was self-reported in the first hour (pain reduction 58,2 and 36,1%). When leaving, pain reduction was the same with the two different assessments. No major adverse event was noted. Conclusion. - Use of oral morphine in ED is simple, with a few numbers of adverse events. None was severe. Efficiency is correct after 30 to 60 minutes.
Unité(s) : CUDR
 
  Analgesia in the pediatric emergency department
CHERON G, COJOCARU B, BOCQUET N
2004 - Archives Pédiatrie 11(1):70-73
Pain concerns more than 50% of the children cared in the emergency unit. After evaluation, it has to be cured with drugs adapted to its level and its origin. Residual pain needs therapeutic adjustment. The goal is to allow the child to restart his activities. A preventive sedation analgesia is necessary when a painful exam is to be performed, either for diagnosis or therapeutic purpose. For this goal ideal analgesics, either for monotherapy or associated, are easily and painlessly administered. They have rapid onset of action, brief half-life, predictable, effective analgesic properties without side effects and they are quickly reversible. These drugs do not exist and every sedation procedure has a risk of hypoxemia. With the human and equipment's investment an emergency department should be able to ensure that procedures are performed in children under sedation with a standard of safety that is similar to general anaesthesia. The main drawback in a well-organised system should be a significant children's rate for which general anaesthesia is preferred.
Unité(s) : CUDR
 
  Apparent life threatening event
CHERON G, COJOCARU B, TIMSIT S
2004 - Archives Pédiatrie 11(6):692-694
Unité(s) : CUDR
 
  Post-traumatic lower limb pain in children
COJOCARU B, CHERON G, GLORION C
2004 - Archives Pédiatrie 11(2):157-161
Injuries to the lower extremity are frequent. They present as pain, reduction of joint function, alteration in gait. Most of the orthopaedic emergencies for teenagers are related to trauma. For younger children, a history of recent fall is prevalent but the non traumatic orthopaedic conditions are especially important to investigate when the reported injury is minor or when onset of symptoms is delayed.
Unité(s) : CUDR
 
  Tumeur cérébrale : une cause inhabituelle de douleurs des membres inférieurs
GUEDDARI W, GAREL D, BARNERIAS C, COJOCARU B, ROSE CS, CHERON G
2004 - Archives Pédiatrie 11(12):1465-1467
Limb pain in children is one of the most frequent reasons to refer to the emergency unit. Most often it suggests an orthopaedic, a muscular, a peripherical neurologic or a spinal affection. We report two cases of recurrent limb pains revealing a central nervous system tumor.
Unité(s) : CUDR
 
  Smoking and sudden infant death syndrome
CHERON G, TIMSIT S
2003 - J. Gynécol. Obst. Biol. Reprod. 32(1 Pt 2):33-40
Assessment of the causation relationship between two phenomena requires the demonstration of an epidemiological association, a temporal and asymmetric sequence, and a biological gradient and identification of the biological mechanism(s). All epidemiological studies on sudden infant death syndrome (SIDS) and smoking have encountered major bias and difficult data interpretation but they all have estimated that maternal smoking caused a 2 to 3-fold increased risk of SIDS. Nicotine may interact with non-neuronal nicotinic receptors in the lung, peripheral nicotinic cholinergic and adrenergic chemoreceptors, and brainstem nuclei and has been largely studied. More accurate knowledge concerning the biochemistry and specific features of nicotinic receptors will be useful to explain the way nicotine alters breathing at rest and during hypoxia. Uncertainty about the casual relationship in no way means the fight against smoking is not warranted.
Unité(s) : CUDR
 
  Urgences Pédiatriques (2ème édition)
BOURRILLON A, CHÉRON G
2002 - Ouvrage 688
Unité(s) : CUDR
 
  Asthma in older children and adolescents seen in an Emergency Room
CHERON G, TIMSIT S, COJOCARU B, SANNIER N
2002 - Rev. Fr. Allergol. Immunol. Clin. 42(6):611-618
During the obligatory passage from being his parent's responsibility to assuming his own therapeutic autonomy, the asthmatic adolescent, as a result of his disease, is exposed to specific risks, including both morbidity and mortality. These risks arise from his personal feelings about his asthma and from his family's beliefs as well. The entire range of morbidity is important : school absenteeism, decreased activity, persistent asthma and inadequate drug prescriptions. Dissatisfaction is frequent, e specially regarding patient-provider communication and knowledge. New strategies of care and education for this age group have to be explored. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserved.
Unité(s) : CUDR
 
  Effet du racecadotril sur le recours aux soins dans le traitement des diarrhées aigües du nourrisson et de l'enfant
COJOCARU B, BOCQUET N, TIMSIT S, WILLE C, BOURSIQUOT C, MARCOMBES F, GAREL D, SANNIER N, CHERON G
2002 - Arch. Pediatr. 9(8):774-779
BACKGROUND: The treatment of diarrhoea relies on the maintenance or restoration of hydration with maintenance of an adequate nutritional intake. Racecadotril has been shown to reduce the stools output during acute diarrhoea. The present work was aimed at measuring the number of emergency department visits for acute diarrhoea either the children received racecadotril or not. METHOD: Racecadotril and rehydration were compared with rehydration alone in children aged three months to three years who had acute diarrhoea and were evaluated in the emergency department (ED). The primary end point was the number of medical exams during the week after starting treatment. Secondary end points were the number of stools during the first 48 hours, the duration of the diarrhoea and the weight on day 7. RESULTS: One hundred and sixty-six children were alternatively randomized to the treated and the control groups. There was no difference for age, degree of dehydration and length of illness before the first visit between the groups. Whatever type of rehydration (oral or i.v.), the treated group had a significant lower number of stools (p < 0.001) and a faster recovery (p < 10(-9)). The children receiving racecadotril needed less additional ED visits for the same episode (p < 0.05). There was no difference for the weight-gain on day 7. CONCLUSIONS: This study demonstrates the efficacy of racecadotril as adjuvant therapy to oral and i.v. rehydration in the treatment of acute diarrhoea and a fewer emergency department second visit before recovery.
Unité(s) : CUDR
 
  Nurse's care of acute asthma in the pediatric emergency department
TIMSIT S, PIGNARD L, DESGRANGES L, MARCHAC V, COJOCARU B, CHERON G
2002 - Rev. Fr. Allergol. Immunol. Clin. 42(6):623-628
Acute asthma represents 5% of visits to pediatric emergency departments. On arrival in the Emergency Department, the nurse must recognize the most seriously affected children, using a simple verbal questionnaire. Both the pediatrician and the nurse are responsible for the care and observation of the patients. The treatment plan includes nebulized beta2mimetics, administration of a corticosteroid, and oxygen when necessary. The nurse is responsible for evaluating the patient's progress and being alert for complications. She has to measure respiratory and cardiac rhythms, peak flow and transcutaneous O-2 pressure repeatedly. The child can be discharged with minimal risk of an exacerbation only if his respiratory status is fully improved and remains stable one hour after the last nebulization (more than 80% of cases). In other cases, the patient will be hospitalised in the respiratory disease unit for further treatment. (C) 2002 Editions scientitiques et medicales Elsevier SAS. All rights reserved.
Unité(s) : CUDR
 
  Apport du bromure d'ipratropium dans la prise en charge des crises d'asthme aux urgences
TIMSIT S, SANNIER N, BOCQUET N, COJOCARU B, WILLE C, BOURSIQUOT C, GAREL D, MARCOMBES F, CHERON G
2002 - Arch. Pediatr. 9(2):117-125
BACKGROUND: To determine if the addition of ipratropium bromide in the emergency department (ED) for the treatment of childhood asthma reduces rates of hospitalization and relapses for moderate and severe exacerbations. METHODS: Patients were given an oral corticosteroid treatment (2 mg/kg) and received every 20 minutes either three nebulizations with albuterol (0.15 mg/kg) and ipratropium bromide (250 micrograms) or six nebulizations with albuterol alone (control group). The primary end point was the need for hospitalization, additional nebulizations or a relapse during the following week. Secondary end point included the effect of age. RESULTS: One hundred and forty three children, two to 15 years old, were randomized to ipratropium or control groups and 121 were evaluated on day seven. As a whole, the control group was less often hospitalized or in relapse than those treated with three nebulizations of albuterol and ipratropium (17.5% vs 37.9%, p < 0.02). The ipratropium group reached the same result after three additional albuterol nebulizations. The benefit of anticholinergic therapy was observed for children less than six years of age who had a similar rate of success (73.5 vs 75.7%). CONCLUSION: The association of ipratropium bromide to the first three doses of the albuterol protocol for acute asthma did not act as well as six nebulizations of albuterol alone. The effect was age dependent and two to six years old children needed more attention. Nevertheless the hospitalization rate did not support the use of ipratropium compared with repeated albuterol nebulizations.
Unité(s) : CUDR
 
  Problèmes pulmonaires. Synthèse
TIMSIT S, SCHEINMANN P
2002 - Arch. Pediatr. 9 Suppl 4(450s-451s
Unité(s) : Pneumologie-Allergologie Pédiatrique, CUDR
 
  Spontaneous pneumomediastinum in children
CHALUMEAU M, LE CLAINCHE L, SAYEG N, SANNIER N, MICHEL JL, MARIANOWSKI R, JOUVET P, SCHEINMANN P, DE BLIC J
2001 - Pediat. Pulm. 31(1):67-75
Spontaneous pneumomediastinum (SPM) is rare in children, mainly affecting male adolescents. It is usually secondary to alveolar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The clinical diagnosis is based on the symptom triad of chest pain, dyspnea, and subcutaneous emphysema. and is also based on Hamman's sign. The diagnosis is confirmed by chest radiography. The main differential diagnosis is esophageal perforation, which requires an esophagogram with contrast when there is the slightest doubt in the diagnosis. Spontaneous pneumomediastinum generally resolves spontaneously within a few days, meaning that ambulatory treatment is usually appropriate. Management consists of treating the underlying cause (if identified), rest, analgesics, and simple clinical monitoring. Predisposing factors should be identified and controlled to prevent recurrence. Cases of idiopathic SPM necessitate diagnostic pulmonary function tests after the acute episode, to establish whether the child has asthma. (C) 2000 Wiley-Liss. Inc. [References: 89]
Unité(s) : CUDR, Pneumologie-Allergologie Pédiatrique, Radiologie Pédiatrique, Chirurgie Pédiatrique, Oto-Rhino
 
  Specificity and costs of pediatric hospitalization
CHERON G
2001 - Archives Pédiatrie 8(5):469-473
Unité(s) : CUDR
 
  Médicaments de l'urgence en pédiatrie
CHERON G, BOCQUET N, TIMSIT S, COJOCARU B
2001 - Rev. Prat. 51(17):1914-1918
Drugs for pediatric emergencies are useful for respiratory (croup, asthma), cardiologic (hypertensive crisis, acute congestive heart failure, arrhythmias, hypoxic spells), neurologic (seizures), metabolic (dehydration, hypoglycaemia), infectious (meningococcemia) or allergic (anaphylaxis) distresses. Pain management is always important whether to relieve or to prevent the discomfort which would happen during diagnosis or therapeutic procedures.
Unité(s) : CUDR
 
  Recommandations de la Société Francophone de Médecine d’Urgence concernant la mise en place, la gestion, l’utilisation et l’évaluation des unités d’hospitalisation de courte durée des services d’urgence
GERBEAUX P, BOURRIER P, CHERON G, FOURESTIE V, GORALSKI M, JACQUET-FRANCILLON T
2001 - J. Eur. Urgences 14(1-2):144-152
Les unités d’hospitalisation de courte durée (UHCD) sont définies administrativement en France comme faisant partie intégrante des services d’urgence depuis 1991 [1]. Un décret a remplacé l’appellation UHCD par l’appellation « zone de surveillance de très courte durée » [2]. Cette appellation est limitative, car elle ne souligne pas le caractère indiscutable d’unité d’hospitalisation de ces unités, ne reflète pas l’ensemble de leurs fonctions et risque d’entraîner une confusion avec l secteur de déchocage de l’unité d’Accueil des urgences. L’appellation UHCD doit donc être préférée. Une enquête récente de la Société Francophone de Médecine d’Urgence a montré que, si certains services en sont équipés depuis plus de vingt ans, seulement 53 % des services d’urgence en sont pourvus [3]. Aux Etats-Unis, ces unités sont appelées Observation Units (unités d’observation). Leur structure et leur mode de fonctionnement sont définis par un texte de recommandations édité par l’American College of Emergency Physicians (ACEP, http : //www.acep.org) [4].
Unité(s) : CUDR
 
  Organization of care during bronchiolitis epidemics
SANNIER N
2001 - Archives Pédiatrie 8(Suppl 1):174S-179S
Unité(s) : CUDR
 
  Economic evaluation of the first episode of bronchiolitis
SANNIER N, BOCQUET N, TIMSIT S, COJOCARU B, WILLE C, GAREL D, BOURSIQUOT C, CHERON G
2001 - Archives Pédiatrie 8(9):922-928
Background. - Each year, a quarter of the children younger than 24 months has respiratory syncytial virus bronchiolitis. The morbidity among high-risk infants and the possible association with the development of asthma lead to propose preventive measures whose cost-effectiveness relationship is unknown. The present work was aimed at measuring costs of a first attack of bronchiolitis. Method. - For children less than two years visited in the emergency department, direct and indirect costs were measured according to the 'Securite Sociale' prices. Associated morbidity, the management of care (inpatient versus outpatient), outpatients' outcome two weeks after the visit, socioeconomic data were recorded. Results. - One hundred eighty three children have been studied. The length of stay for 40 hospitalizations was 7.6 +/- 4.3 days. Direct costs were 37 200 +/- 22-000 FF for inpatients, and 1286 +/- 633 F for outpatients. For 113 outpatients' families, indirect costs were 49 working days lost. The way the child was looked after and the unemployment rate in the study were similar to data provided by the National Institute of Statistics and Economic Studies. Conclusion. - Because of the variability of the hospitalization rate from one setting to another, overall costs of the epidemic cannot be evaluated. For the policymaker the greatest costs come from the outpatient care. Others studies will be necessary to evaluate the price of future preventive measures. (C) 2001 Editions scientifiques et medicales Elsevier SAS. [References: 39]
Unité(s) : CUDR
 
  Hospitalization criteria of an emergency asthma attack
SANNIER N, TIMSIT S, BOURSIQUOT C, GAREL D, BOCQUET N, CHERON G
2001 - Archives Pédiatrie 8(Suppl 2):256S-258S
Unité(s) : CUDR
 
  Vitamin d status of pregnant palestinian women
SOUBERBIELLE JC, AL MASRI M, CHERON G
2001 - Archives Pédiatrie 8(4):447-448
Unité(s) : CUDR, Explorations Fonctionnelles
 
  Off label and unlicensed drug use among french office based paediatricians
CHALUMEAU M, TRELUYER JM, SALANAVE B, ASSATHIANY R, CHERON G, CROCHETON N, ROUGERON C, MARES M, BREART G, PONS G
2000 - Arch. Dis. Child. 83(6):502-505
Aims-To determine the extent of off label and unlicensed drug use in French office based paediatric practice. Methods-A prospective one day survey of all written prescriptions, for patients under 15 years, among 95 office based paediatricians in the Paris, France metropolitan area. Main outcome measures were: comparison of the use of each drug with its product Licence for age, indication, dose, and route of administration. Results-A total of 2522 prescriptions were administered to 989 patients; 844 (33%) were used either in an unlicensed (4%) or an off label (29%) manner. A total of 550 (56%) paediatric patients received one or more off label prescriptions. Conclusions-Off label prescriptions (that is, outside the terms of the Summary of Product Characteristics) are widespread in office based paediatric practice, while unlicensed drug use is rare in our study. New regulations in the licensing process in Europe are needed to allow children to receive drugs that have been fully evaluated in their specific age group. [References: 29]
Unité(s) : CUDR
 
  Etiological and pathogenetic basis of the management of apparent life-threatening events in infants
CHERON G
2000 - Archives Pédiatrie 7(12):1339-1343
Apparent life-threatening events in an infant require: 1/ to determine the seriousness of the event; 2/ to identify ifs etiology; 3/ to evaluate the risk of recurrence and the need for appropriate preventive measures. Management mainly depends upon the determination of the etiology and the understanding of the pathogenetic mechanism. Gastroesophageal reflux is the main etiology. Therefore whenever symptoms of gastroesophageal reflux are present, this has to be considered as the first etiological hypothesis. Other etiologies will be searched for if orientating symptoms or anamnesis information is present, leading to specific investigations. (C) 2000 Editions scientifiques et medicales Elsevier SAS. [References: 11]
Unité(s) : CUDR
 
  Ambulatory management of acute pyelonephritis in children
SANNIER N, LE MASNE A, SAYEGH N, GAILLARD JL, CHERON G
2000 - Acta Paediatr. 89(3):372-373
Unité(s) : Laboratoire de Microbiologie, CUDR
 
  Ontogenesis of cyp2c-dependent arachidonic acid metabolism in the human liver: relationship with sudden infant death syndrome
TRELUYER JM, BENECH H, COLIN I, PRUVOST A, CHERON G, CRESTEIL T
2000 - Pediat. Res. 47(5):677-683
A modification of the human monooxygenase system have been previously associated with the sudden infant death syndrome (SIDS): the hepatic CYP2C content was markedly enhanced and resulted from an activation of CYP2C gene transcription. To determine the possible consequence of the up-regulation of CYP2C in SIDS, we examined the metabolism of arachidonic acid (AA) an endogenous substrate of CYP2C involved in the physiologic regulation of vascular tone. The overall AA metabolism was extremely low during the fetal period and rose after birth to generate 14,15 epoxyeicosatrienoic acid (EET), 11,12 EET and the sum of 5,6 dihydroxyeicosatrienoic acid (diHETE)+omega/omega-1 hydroxy AA. In SIDS, the accumulation of CYP2C proteins was associated with a significant increase in the formation of 14,15 and 11,12 diHETE, which were shown to be supported by individually expressed CYP2C8 and 2C9 and HETE1 (presumably 15 METE). This increase was markedly inhibited by addition of sulfaphenazole, a selective inhibitor of CYP2C9. So, we propose that the higher CYP2C content in SIDS stimulates the production of EETs and diHETEs and might have severe pathologic consequences in children. [References: 36]
Unité(s) : CUDR, U075
 
  "Life threatening events in infancy": plea for a semiologic approach and rationalization of examinations
CHERON G, SANNIER N
1999 - Archives Pédiatrie 6 Suppl 2(392s-396s
Unité(s) : CUDR
 
  Medical problems of internationally adopted children
LE MASME A
1999 - Archives Pédiatrie 6(5):569-572
Adopted children from foreign countries represent a high risk population for infectious diseases, nutritional problems and neuro-developmental delay. Medical screening including clinical and biological evaluation is recommended after arrival. (C) 1999 Elsevier, Paris. [References: 14]
Unité(s) : CUDR, Département de Pédiatrie
 
  Intussusception in infants and children: feasibility of ambulatory management
LE MASNE A, LORTAT-JACOB S, SAYEGH N, SANNIER N, BRUNELLE F, CHERON G
1999 - Eur. J. Pediat. 158(9):707-710
To evaluate the ambulatory management of ileo-colic intussusception in infants and children, a retrospective study over 3 years of 113 children treated for ileo-colic intussusception ill a paediatric emergency department was undertaken with the aim of shortening the length of stay. A total of 113 children aged 10 days to 9 years (median 12 months) were treated for intussusception between January 1993 and December 1996. None had septic shock or peritoneal aeric effusion. Barium enema reduction was attempted in all patients. Successful reduction rate was 81%. Fifty patients (44.2%) were completely ambulatory managed and 42 were hospital-supervised after successful enema reduction. Twenty-one children underwent laparotomy after failure of enema. With the ambulatory device, costs were reduced ($1000/case) compared with conventional in-patient treatment.
Unité(s) : CUDR, Radiologie Pédiatrique
 
  Development of a pediatric multiple organ dysfunction score: Use of two strategies
LETEURTRE S, MARTINOT A, DUHAMEL A, GAUVIN F, GRANDBASTIEN B, NAM TV, PROULX F, LACROIX J, LECLERC F
1999 - Med. Decis. Making 19(4):399-410
Background. An organ dysfunction (OD) scoring system for critically ill children is not yet available, and the method for developing such a system is not well defined. The aim of this study was to compare two developmental methods for assessing OD in critically ill children. Methods. Consecutive admissions between January and May 1997 in three French and Canadian pediatric intensive care units (PICUs) were studied prospectively. Physiologic data were selected using a Delphi method; the most abnormal values during PICU stay were recorded. The outcome measure was the vital status at PICU discharge. Six organ systems were studied: hepatic, cardiovascular, renal, hematologic, respiratory, and neurologic. For each of the six organ systems, the PEdiatric Multiple OD (PEMOD) system included one variable and the PEdiatric Logistic OD (PELOD) system included several variables. Severity levels and relative weights of ODs were determined according to the mortality rate (PEMOD) or by logistic regression (PELOD). Results. There were 594 admissions, including 51 deaths (9%). Severity levels and relative weights of ODs were: four levels graded from 1 to 4 for the PEMOD system and three levels with scores of 1, 10, and 20 for PELOD system. For both systems, calibrations were good (p = 0.23 and p = 0.44 respectively). The PELOD system was more discriminant than the PEMOD system (areas under the ROC curves 0.98 and 0.92, respectively, p < 10(-5)). Moreover, with the PEMOD system, four ODs did not contribute significantly to the prediction of PICU outcome. Conclusions. The PELOD system was more discriminant and had the advantage of taking into account both the relative severities among ODs and the degree of severity of each OD. [References: 39]
Unité(s) : CUDR
 
  Fetal urine cystatin C as a predictor of postnatal renal function in bilateral uropathies
MULLER F, BERNARD MA, BENKIRANE A, NGO S, LORTAT-JACOB S, OURY JF, DOMMERGUES M
1999 - Clin. Chem. 45(12):2292-2293
Unité(s) : CUDR
 
  Ambulatory management of acute pyelonephritis in children. Experience in a pediatric emergency department
SANNIER N, LE MASNE A, SAYEGH N, GAILLARD JL, CHERON G
1999 - Ann. Pédiatr. 46(2):104-112
Background:evaluation of ambulatory management with a single parenteral antibiotic treatment for uncomplicated pyelonephritis in children. Population and methods: Retrospectively analysis of 225 children with a suspicion of uncomplicated pyelonephritis between 1/1/95 to 30/6/96. The children were treated with a single dose per day of ceftriaxone for four days, followed by ten days of oral antibiotherapy. Fever duration, repeat urine culture, cystourethrography, surgical treatment and relapse were monitored. Results: 130 children from I month to 15 years met criteria commonly accepted for pyelonephritis diagnosis. After 12 months of age pyelonephritis was more common in girls and 43% of the population were younger than 1 year. E, coli. was isolated in 94% of them. Fever disappeared and urine was sterilized within 72 hours. Cystourethrography was undertaken in 112 cases. One posterior urethral valves and 43 vesicoureteral reflux (38%) were discovered. A third of them was surgically repaired during follow up. One relapse occured 3 weeks later. Follow-up from 9 to 27 month was possible for 104 children (80%). Conclusion : When families fully understand the treatment, ambulatory management of common pyelonephritis with one parenteral antibiotic is safe, on condition families agreed to the treatment modes. To chose between one or two antibiotic strategies, further studies with early and late DMSA renal scans are needed to detect renal scar incidence. [References: 29]
Unité(s) : CUDR
 
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