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.

Emergency consultations for male adolescents: Somatic and psychological characteristics and profiles of regular users. A retrospective chart review.

INTRODUCTION: Male adolescents' mental health has been understudied compared to their female counterparts and is not well known among health professionals. This is particularly problematic in emergencies because the number of such patients is increasing. OBJECTIVES: To identify the type of demand for care and the characteristics of male adolescents' emergency room visits. To describe the sociodemographic data and clinical characteristics of regular users. METHOD: This is a retrospective study of all medical records of male adolescents aged 14-18, admitted between 2014 and 2015 to the pediatric emergency room of a Swiss university hospital. Sociodemographic and clinical data (e.g., degree of urgency, diagnosis, length of stay, emergency service use, and emergency discharge destinations) were collected. Descriptive and multivariate analyses were performed using STATA 13.1 software. RESULTS: Over the 2-year study period, 2045 male adolescents consulted in emergency departments for a total of 3199 admissions. The average age was 15.6 years (SD, 1). Most consultations were non-urgent (93%) and the reasons included musculoskeletal (43%), dermatological (13%), and digestive (10%) complaints. Forty-two male adolescents (2%) had four or more visits within the 2-year period and were considered regular users; they were also more likely to have psychological complaints (adjusted OR, 5.04; 95% CI, 1.81-13.72) and comorbidities (adjusted OR, 2.55; 95% CI, 1.25-5.21) when compared to their counterparts with fewer than four visits. CONCLUSION: Since regular users are at greater risk of having psychological complaints and comorbidities during their first emergency room visit, a systematic assessment of these adolescents' mental health levels and overall health indicators is recommended.

[Families' experiences and satisfaction with a pediatric emergency service]. / Familles fréquentant un service d'accueil des urgences pédiatriques : expérience, satisfaction et besoins.

OBJECTIVE: Today, pediatric emergency services receive a rising number of "non-urgent" cases, which are due to parental anxiety or a miscomprehension of medical explanations. The aim of this study was therefore to understand what those families experience and need when they consult in such cases, in order to respond with adapted solutions. METHODS: Semi-structured interviews and questionnaires with parents, after the consultation or in the waiting room. RESULTS: Based on the families' narratives, we present the results in six steps, which correspond to the steps they experience from the decision to go to the hospital to the consultation. Families' experiences are very satisfactory regarding the quality of medical care, the relationship between staff and children, and the staff's overall attitude. Critical points concern practical aspects (parking, food, and play facilities); the waiting time and the lack of information; and the communication between the medical staff and the parents, most particularly related to their anxiety and waiting time. DISCUSSION: The results show first that parents have multiple preoccupations: many stress factors and organizational difficulties are added to their child's disease. These preoccupations are mostly related to the lack of information about the waiting time, information that they would need to organize their day and their time in the hospital. Second, the results show that parental anxiety influences their decision to come to the emergency department, their experience of care and of the waiting time, and their judgment about the quality of the medical care. Considering this, families requested practical improvements (i.e., more toys in the waiting room), and suggest more communication and presence from the medical staff. Based on their demands, we suggest an agenda of care in four steps: a waiting time, a time for sharing, a time for information giving, and a validation time. CONCLUSIONS: Overall, parents are stressed and anxious when they come to the emergency department and request more reassurance, attention, and explanations from the healthcare staff. We propose a final "validation time" to verify that the medical explanations are understood as well as the emotional state of the family. In this way, we can ensure good follow-up care at home, avoid unnecessary readmissions, and promote parental health education.

[Paediatric emergency: creation of an independent nurse practitioner consultation]. / Pédiatrie. 4. Urgences pédiatriques: création d'une consultation infirmière indépendante.

Consultations in the Paediatric Emergency Department (PED) continue to climb regularly. Emergency Nurse Practitioner consultations have long been created in the English speaking countries. Since January 2013, an indepen- dent nurse consultation, under delegated medical responsibility, exists in the multidisciplinary PED of the Children's Hospital of Lausanne. The mean consultation time is the same as the medical consultation and the overall waiting time hasn't decreased yet. But a well definite working frame, a systematic approach, as well as the continual medical supervision possibility, make it a safe, efficient and appreciated consultation, by both patients and professionals.

[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.

[Sport: practiced from birth?]. / Le sport: dès la naissance?

Physical activity in children is on the decline, leaving room for sedentary behaviour. Children are mentally over stimulated through the use of screens, but their physical condition is diminishing. The benefits of physical activity in adults are well known. Although paediatric literature is less abundant, the benefits of regular physical activity in young children are real and extend into adulthood. The promotion of physical activity can be made by any responsible adult in a child's entourage. It means clarifying the confusion between physical activity and sport, evaluating the balance between the physical and sedentary behaviour of the children and their families and establishing with them the possible necessary changes. PAPRICA--young childhood is 4 hour interdisciplinary training session approaching these various themes.

[Impact of a small-group educational intervention for 4- to 12-year-old asthmatic children and their parents on the number of healthcare visits and quality of life]. / Impact d'une école de l'asthme sur la consommation en soins et la qualité de vie des enfants âgés de 4 à 12ans et de leurs parents.

INTRODUCTION: Asthma is the most frequent chronic disease in children. Many educational approaches to asthma exist, but there is no evidence of their effectiveness because of the heterogeneity of practices. Several studies show that good knowledge of the disease associated with personal skills and optimal medication improve treatment compliance and decrease school absenteism and asthma exacerbations. The "Asthma School" conducted in the Children's Hospital of Lausanne, Switzerland is in keeping with these recommendations. The aim of the study was to evaluate the impact of Asthma School (therapeutic education) on the number of medical visits in asthmatic children. We also assessed the quality of life of children and their caregivers. METHODS: We included in a prospective longitudinal study every child aged 4 to 12 years and their parents attending Asthma School over 1 year and followed them at 6 months. The number of emergency visits, medical appointments, and hospitalizations during the year before and after Asthma School was assessed with a questionnaire administered to the family physicians (GPs, pediatricians). Quality of life was evaluated with the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) at inclusion and 6 months after. RESULTS: Twenty-seven children and their parents were included. The mean age was 7.02 years. Pediatric visits, emergency visits, and hospitalizations decreased significantly between the year before and the year after Asthma School. Emergency visits were 41, 1 year before Asthma School and 21, 1 year after it, medical appointments were 62 vs 30, and hospitalizations were 17 vs 2, respectively. The Wilcoxon sign-rank test demonstrates a significant difference with P=0.010 for medical appointments, P=0.021 for emergency visits, and P=0.002 for hospitalizations. Quality of life in children improved in all domains but one evaluated by the PAQLQ(S) (score of 5.90 vs 6.52). Parental quality of life (PACQLQ) improved in all domains (overall score of 5.21 vs 6.15). CONCLUSION: Interactive education on asthma improves clinically important outcomes and quality of life in children and their families. The skills acquired allow them to manage daily life.

[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. Screening for nutritional deficiencies in hospitalized children: new practices at the Hôpital de I'Enfance in Lausanne]. / Pédiatrie. 4. Dépistage de la dénutrition chez les enfants: nouvelles pratiques alimentaires à l'Hôpital de l'Enfance de Lausanne.

Screening for undernutrition among hospitalized children requires a systematic assessment of dietary intake. The development of a new tool for quick and playful assessment of dietary intake, called "Fleur" ("Flower"), at the Hôpital de l'Enfance in Lausanne allows to identify children at risk of undernutrition and to adapt their nutrition to their specific needs.

[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.

[Intestinal intussusception in children: truly a classic triad?]. / Invagination intestinale chez l'enfant: une triade vraiment classique?

Intussusception in children is not a frequent pathology but it is important to consider when working in a paediatric emergency department due to the potential serious complications in the case that the diagnosis is not rapidly identified. The majority of cases are idiopathic and in only 10% of patients will a pathological lead point be found. One would be in error to wait for the classical triad presentation before beginning the appropriate diagnostic testing. Hence, the diagnosis of intussusception should be suspected in all children, under the age of 3 years, with acute colicky abdominal pain. In this practical review, we have included the clinical experience in intussusception seen in 2 Swiss university paediatric hospitals.

[Pediatrics. The PAT: a simple and rapid tool for the assessment of the severely ill or injured child]. / Pédiatrie. 2. Le TEP: outil de triage recommandé pour l'évaluation de l'enfant gravement malade ou accidenté.

The Pediatric Assessment Triangle (PAT) has become the cornerstone for the assessment and treatment of a critically ill or injured infant/young child. Now incorporated to the PALS course, it can be taught to all levels of health care providers in charge of severly-ill children. The PAT is a rapid and simple observational tool suitable for pediatric assessment regardless of complaint or underlying diagnosis. It can be introduced in every emergency department, especially those having relatively infrequent encounters with very sick children. Implementation of such a tool needs formal theoritical and practical education skills, rapid availability of experienced pediatric seniors and spaces specifically intented for children.

Immunity to pneumococcal surface proteins in children with community-acquired pneumonia: a distinct pattern of responses to pneumococcal choline-binding protein A.

The aetiological diagnosis of community-acquired pneumonia (CAP) is challenging in children, and serological markers would be useful surrogates for epidemiological studies of pneumococcal CAP. We compared the use of anti-pneumolysin (Ply) antibody alone or with four additional pneumococcal surface proteins (PSPs) (pneumococcal histidine triad D (PhtD), pneumococcal histidine triad E (PhtE), LytB, and pneumococcal choline-binding protein A (PcpA)) as serological probes in children hospitalized with CAP. Recent pneumococcal exposure (positive blood culture for Streptococcus pneumoniae, Ply(+) blood PCR finding, and PSP seroresponse) was predefined as supporting the diagnosis of presumed pneumococcal CAP (P-CAP). Twenty-three of 75 (31%) children with CAP (mean age 33.7 months) had a Ply(+) PCR finding and/or a ≥ 2-fold increase of antibodies. Adding seroresponses to four PSPs identified 12 additional patients (35/75, 45%), increasing the sensitivity of the diagnosis of P-CAP from 0.44 (Ply alone) to 0.94. Convalescent anti-Ply and anti-PhtD antibody titres were significantly higher in P-CAP than in non P-CAP patients (446 vs. 169 ELISA Units (EU)/mL, p 0.031, and 189 vs. 66 EU/mL, p 0.044), confirming recent exposure. Acute anti-PcpA titres were three-fold lower (71 vs. 286 EU/mL, p <0.001) in P-CAP children. Regression analyses confirmed a low level of acute PcpA antibodies as the only independent predictor (p 0.002) of P-CAP. Novel PSPs facilitate the demonstration of recent pneumococcal exposure in CAP children. Low anti-PcpA antibody titres at admission distinguished children with P-CAP from those with CAP with a non-pneumococcal origin.

[Utility of Gamma Interferon blood tests in the diagnosis of tuberculosis infection in children]. / Utilité des tests sanguins intérferon gamma dans le diagnostic de l'infection tuberculeuse chez l'enfant.

Considering the ongoing difficulty with the interpretation of the tuberculin skin test and the importance of a correct interpretation of each situation in order to benefit from treatment, a lot of expectations are placed in the new Gamma Interferon blood tests. The aim of this article is to recall the basic principles of these tests and to review the evidence of their utility in paediatrics. In children, although the evidence is still insufficient, the blood tests can be useful in combination with the tuberculin skin test.

[Pediatry]. / Pédiatrie.

During the previous year, several changes occurred in paediatric patient's management. The new PALS recommendations redefine the rhythm and the rate between cardiac massage and ventilation as well as the indications for defibrillation. The choice of the test for Helicobacter Pylori depends on the age of the patient and on the clinical situation. New anti-hypertensive drugs allow to limit the progression of chronic renal disease with hyper-tension and/or proteinuria. The choice between immunoglobulins, steroids, splenectomy and rituximab to treat chronic thrombocytopenic purpura treatment is a therapeutic challenge. Finally, a new approach is presented for diagnosis and treatment of iron overload in chronic hemoglobinopathies.

[Recognition of cardiorespiratory distress and failure in children]. / Reconnaissance des signes de gravité cardiorespiratoire chez l'enfant.

Every pediatrician and general practitioner can face children with life-threatening conditions in their private practice. Recognition of symptoms of respiratory failure and shock is essential to initiate therapy promptly in order to prevent the development of cardiopulmonary failure. This article provides clinical information on detecting critical respiratory and cardiac conditions, anticipating cardiac arrest in children, establishing priorities in care, and transferring to an emergency center.