Risk factors for urinary tract infections in children aged 0-36months presenting with fever without source and evaluated for risk of serious bacterial infections.

BACKGROUND: Children younger than 36 months with fever without a source (FWS) are at risk of serious bacterial infections (SBI). The risk of occult bacteremia (OB) has been greatly reduced in vaccinated children. The aim of this study is to describe the epidemiology of SBI in children with FWS in our setting and to evaluate the performance of our management algorithm. METHODS: We designed a prospective cohort study. We included children aged 0-36 months presenting with FWS in our emergency unit. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Information on clinical evolution, final diagnosis, and immunization history were obtained after 10 days. Potential predictors of SBI were compared between patients with and without SBI. RESULTS: Between October 2015 and September 2017, 173 children were recruited, with a median age of 4.4 months (2.1-1). Of these children, 166 (96%) were up to date with their vaccinations. A total of 47 children (27%) had a final diagnosis of SBI, which were all urinary tract infections (UTI). Presence of chills (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.3-24.3), fever for>2 days (OR 29.1, 95% CI 3.5-243.5), and age<9 months (OR: 45.3, 95% CI: 4.9-415.7) were statistically significant predictors of UTI in a multivariate logistic regression. The sensitivity and specificity of our management algorithm were 100% (95% CI: 92.4-100%) and 21.4% (14.6-29.6%), respectively. CONCLUSIONS: In the setting of high vaccination coverage, we only identified SBI related to UTIs. We could not identify any OB. Our management algorithm was able to identify all SBI, but specificity was low. Refined criteria for screening of UTI could slightly increase this.

[Which maintenance intravenous fluid in paediatrics in 2015?]. / Pédiatrie. 5. Quel soluté de maintenance intraveineux en pédiatrie en 2015?

For 50 years, hypotonic solutions have been used as liquid of maintenance in paediatrics owing to the article of Holliday and Segar. For two decades, studies have shown that these hypotonic fluids can foster the acquisition of hyponatremias. The most recent literature data (meta-analysis and randomized studies) confirm that hypotonic fluids are not suitable for children hospitalized with surgical or medical problems. Current recommendations must take these results into account and advocate the use of isotonic saline solutions as maintenance intravenous fluid therapy.

Which clinical signs predict hypoxaemia in young Senegalese children with acute lower respiratory tract disease?

BACKGROUND: Acute lower respiratory tract diseases are an important cause of mortality in children in resource-limited settings. In the absence of pulse oximetry, clinicians rely on clinical signs to detect hypoxaemia. OBJECTIVE: To assess the diagnostic value of clinical signs of hypoxaemia in children aged 2 months to 5 years with acute lower respiratory tract disease. METHODS: Seventy children with a history of cough and signs of respiratory distress were enrolled. Three experienced physicians recorded clinical signs and oxygen saturation by pulse oximetry. Hypoxaemia was defined as oxygen saturation <90%. Clinical predictors of hypoxaemia were evaluated using adjusted diagnostic odds ratios (aDOR). RESULTS: There was a 43% prevalence of hypoxaemia. An initial visual impression of poor general status [aDOR 20.0, 95% CI 3.8-106], severe chest-indrawing (aDOR 9.8, 95% CI 1.5-65), audible grunting (aDOR 6.9, 95% CI 1.4-25) and cyanosis (aDOR 26.5, 95% CI 1.1-677) were significant predictors of hypoxaemia. CONCLUSION: In children under 5 years of age, several simple clinical signs are reliable predictors of hypoxaemia. These should be included in diagnostic guidelines.

[Pediatrics. Using the McIsaac score for the indication of rapid diagnostic testing in children with streptococcal pharyngitis]. / Pédiatrie. 3. Le score de McIsaac: une aide à l'indication des tests de diagnostic rapide dans tes angines à streptocoques A.

The McIsaac scoring system is a tool designed to predict the probability of streptococcal pharyngitis in children aged 3 to 17 years with a sore throat. Although it does not allow the physician to make the diagnosis of streptococcal pharyngitis, it enables to identify those children with a sore throat in whom rapid antigen detection tests have a good predictive value.

[Pediatrics]. / Pédiatrie.

Several preliminary studies suggest that prophylactic administration of probiotics reduces the incidence of necrotizing enterocolitis (NEC) in preterm infants, and several neonatology units have introduced this treatment under strict surveillance. Nonetheless, breast milk feeding remains the mainstay of NEC prevention. The beta-blocker propranolol, known for its effectiveness on cutaneous hemangiomas, is also proving useful for the treatment of subglottic or visceral hemangiomas. Following the decrease in severe bacterial infections thanks to widespread vaccinations, the McCarthy clinical score has regained importance in the prediction of the risk of bacterial infection in febrile infants. It is easy to use, economical, and has a diagnostic value comparable to laboratory tests. The new WHO growth charts have been introduced in Switzerland in 2011 to take into account the increasing regional and ethnic variations in our country. Any significant change in growth velocity should prompt an evaluation of the need of further investigations.

Chronic oxygen dependency in infants born at less than 32 weeks' gestation: incidence and risk factors.

OBJECTIVE: To assess incidence and clinical risk factors of chronic oxygen dependency (COD) among survivors who were born at or before 31 weeks' gestation. METHODS: This prospective, multicenter study enrolled 802 infants who were born at or before 31 weeks' gestation and admitted to 8 level III neonatal intensive care units in northern and eastern France from January 1 through December 31, 1997. Need for oxygen to maintain oxygen saturation between 92% and 96% was assessed at 28 days of life and at 36 and 42 weeks' postconceptional age (PCA). Stepwise logistic regression analysis was used to identify the incidence of COD and the risk factors related to its occurrence. RESULTS: The mortality rate was 14%. Antenatal corticotherapy was administered to 51% of patients, surfactant therapy to 76% of the ventilated patients, and high-frequency oscillatory ventilation at day 1 to 32%. At 28 days and 36 and 42 weeks' PCA, respectively, 25%, 15%, and 6% of survivors had COD. After adjustment for intercenter variations, we identified the significant risk factors for COD at these dates: a low gestational age, a high score on the Clinical Risk Index for Infants, intrauterine growth restriction, and surfactant treatment. CONCLUSION: COD incidence was high at 28 days of life but decreased dramatically by 42 weeks' PCA. This study confirmed previously reported risk factors and underlined the importance of intrauterine growth restriction and the Clinical Risk Index for Infants as significant risk factors.

Some risk factors for cerebral palsy in very premature infants: importance of premature rupture of membranes and monochorionic twin placentation.

OBJECTIVE: To delineate the perinatal risk factors of neurodevelopmental disabilities in very preterm birth applying logistic regression analysis. DESIGN: This prospective, geographically defined collaborative study was carried out in the Franche-Comté region of France. SUBJECTS: From October 1, 1990 to September 30, 1992, perinatal and follow-up data were collected on 203 consecutive live-born singleton or twin non-malformed infants with strictly ascertained gestational ages of less than 33 weeks. MAIN OUTCOME MEASURE: The rate of cerebral palsy and/or severe mental retardation as diagnosed by a family physician or pediatrician with a screening-skill test performed at 2 years of age. RESULTS: 167/171 (98%) survivors were evaluated. Twenty-two of the 167 examined infants (13%) showed signs of cerebral palsy, and 10 of these had severe cerebral palsy or mental retardation. Risk factors for disabilities were selected by a multivariate approach: premature rupture of membranes >/=48 h (OR 4.3, 95% CI 1.6-11.8); monochorionic twin placentation (OR 6.0, 95% CI 1.7-21.3), and respiratory distress syndrome (OR 2.8, 95% CI 1.1-7.1). CONCLUSION: This geographically defined prospective study gives epidemiological data and highly suggests that there is a link between prenatal events (premature rupture of membranes, monochorionic twin placentation), postnatal events (respiratory distress syndrome), and neurological disabilities in former preterm infants.

Use of energy color Doppler in visualizing fetal pulmonary vascularization to predict the absence of severe pulmonary hypoplasia.

OBJECTIVE: The aim of our study was to determine if the assessment of pulmonary vascularization by energy color Doppler during ultrasound examination can predict the absence of pulmonary hypoplasia before birth in situations where it is a high risk. METHODS: In a prospective study of 12 pregnancies presenting a risk of pulmonary hypoplasia (5 early and prolonged premature ruptures of the membranes, 1 diaphragmatic hernia, 1 chylothorax, 1 pulmonary sequestration, 1 omphalocele, 1 anamnios and 2 Potter's syndromes) energy color Doppler was used to visualize pulmonary vascularization. RESULTS: In 10 cases where pulmonary vascularization could be visualized, none of the infants had pulmonary hypoplasia. In the 2 cases of Potter's syndrome where pulmonary vascularization was not visualized there was a pulmonary hypoplasia. CONCLUSION: The visualization of fetal pulmonary vascularization with energy color Doppler in situations with a high risk of pulmonary hypoplasia can predict the absence of severe pulmonary hypoplasia.