[Hydrocephalus in children]. / Hydrocéphalie chez l'enfant: étiologies--traitements--résultats.

The files of all young patients, aged from one day to 17 years, that were operated for hydrocephalus in the Service of Neurosurgery of the Citadelle Hospital from 1987 to 2003 were reviewed and analysed. Over these 16 years of practice, a shunt was placed in a total of 194 children. This paper is mainly concerned with the etiologies of hydrocephalus and the complications related to the surgical procedure.

[Inborn errors of metabolism: new developments and challenges]. / Evolution et défis de la pédiatrie en Belgique et en Europe.

The recent evolution of hospital pediatrics in Western Europe results from the scientific progresses in preventive and curative medicine, from epidemiological changes related to environmental factors, from populations expectations about health and from the socioeconomical evolution. As a consequence, hospital pediatric activities have evolved toward the management of more chronic et complex diseases, requiring multidisciplinary approachs. In this context, the role of the "hospitalist" clinician, of family-oriented care, of coordination of inteventions and of minimization of complications during hospitalization need to be emphasized. The teaching of pediatrics has quickly evolved toward practical and interactive activities, organized in small groups. In a few years, EBM has spread like an epidemic in the scientific community. Clinical and epidemiological research remains underdeveloped in many European countries. This research needs to be boosted with the help of national European and private sponsors. European pediatric departments also have to develop their expertise in the field of research in developing countries.

[Vaccinations in HIV-infected children]. / Vaccins classiques et moins classiques chez l'enfant infecté par le VIH.

The increased vulnerability of HIV infected children to infections supports the principle of vaccination. This article summarizes the available data on the practice of vaccination among HIV infected children. Vaccination is, in general, harmless and efficacious in those children. The World Health Organisation (WHO) guidelines are very similar to other recommandations. Nevertheless, the HIV related immunosuppression reduces the vaccination benefits. Moreover, serious complications are possible after BCG-vaccine administration in seriously immunocompromised children. Therefore, children with AIDS should not be given this vaccine. The benefits of anti-poliomyelitis and anti-measles vaccination markedly exceed the low post-vaccination risk reported among these children.

[The return of pertussis]. / Le retour de la coqueluche.

Pertussis (whooping cough) is a contagious respiratory tract bacterial infection due to Bordetella pertussis who makes global comeback despite routine vaccination. Bordetella pertussis produces a series of virulence factors that are involved in one of several steps of the pathogenesis of whooping cough (adhesins, toxins). Unusual presentations are now most common. Clinical diagnosis of whooping cough is often difficult, and microbiologic evaluation is helpful. Treatment is based on antibiotherapy and sometimes intensive care management. Complications are most common in children younger than 6 months (death, malignant pertussis, respiratory and neurological complications). Pertussis can be controlled by treatment of exposed people and by vaccination.

[Infections and antibiotic prophylaxis in sickle cell disease]. / Infections et prophylaxies antiinfectieuses dans la drépanocytose.

Bacterial infections remain a major cause of morbidity and mortality among young children with sickle cell disease. Susceptibility to infections is mainly observed in homozygous sickle cell disease. The incidence of bacteremias in children under 3 years of age is approximately 8 events/100 patient-years among homozygous subjects and approximately S events/100 patient-years among those with SC hemoglobinopathy. Pneumococci and Salmonellae are the most frequently isolated bacteria. Severe clinical manifestations include septicemia, meningitis, osteomyelitis and pneumonia. M. Pneumoniae and C. Pneumoniae infections may be severe and may induce acute chest syndrome. The high incidence and severity of bacterial infections in these children justify prevention efforts by antibiotic prophylaxis and vaccination. The efficacy of oral penicillin prophylaxis against pneumococcal infections has been well demonstrated and is now recommended from 3 months of age. The antipneumococcal conjugate vaccine has been shown to be safe and immunogenic in young infants.

Patterns of physical activity defined by continuous heart rate monitoring among children from Liège.

Health benefits of a physically active lifestyle are well documented. We therefore investigated the physical activity patterns of 200 children from Liège. They were monitored continuously using a 24-hour Holter monitoring system during normal weekdays and the percentage of heart rate reserve (%HRR) was used to measure the amounts of physical activity at different intensities. Preschool children attained 184.3+/-54.2, 40.7+/-16.1, 15.8+/-6.9 and 6.0+/-7.2 minutes/day (mean+/-SD) between 20% to 40%, 40% to 50%, 50% to 60%, and greater than 60% of HRR, respectively. At the same %HRR intensities, schoolchildren attained 165.6+/-74.6, 32.1+/-12.1, 15.8+/-6.7 and 7.0+/-5.9 minutes/day, and teenagers attained 159.2+/-68.3, 32.1+/-23.5, 13.1+/-6.0 and 6.1+/-6.3 minutes/day. Age was a significant predictor of the intercept and slope of the time spent in physical activity and %HRR relationship. In Liège the average youth accumulates +/-30 to 40 minutes/day of moderate-intensity physical activity and +/-20 minutes/day of high-intensity physical activity. Those children meet the classical revised guidelines for physical activity but do not compare favourably with children from elsewhere. On the other hand, they get more than 2 1/2 to 3 hours/day of low-intensity physical activity. Our findings suggest that children from Liège are not engaged in sedentary behaviour but do not experience the ideal amount and type of physical activity classically believed to benefit the cardiopulmonary system. Public health strategies should be adapted to our findings.

[Mixed connective tissue disease in childhood: report of two clinical cases]. / Les connectivites mixtes chez l'enfant: illustration par deux cas cliniques.

Sharp's syndrome, or mixed connective tissue disease, is an autoimmune chronic disease characterized by a tissue collagen abnormality. It is more common among young women, but is also described in children. The symptomatology may be different from one case to another as shown in the two presented cases. Signs and symptoms of other rheumatic diseases are commonly observed. The presence of anti-RNP antibody is requested to confirm the diagnosis. The treatment is adapted to each individual. Non-steroidal anti-inflammatory drugs, corticosteroids, and immunosuppressive drugs are the basis of treatment.

[Prevention of bacterial endocarditis]. / La prévention de l'endocardite bactérienne.

Because of its severity, it is agreed that infectious endocarditis should be prevented whenever possible. Certain patient populations at risk for endocarditis have been identified. Antibiotic prophylaxis is therefore recommended when these individuals undergo procedures likely to cause bacteremia with organisms that cause endocarditis. In this article we attempt to provide a comprehensive approach to infectious endocarditis prophylaxis based both on the pathophysiology of the disease and on the mechanisms of action of prophylactic drugs. Approaches to the prevention of endocarditis have been recently modified and are reviewed in this paper, especially important issues for the primary care physician.

[Observations and reflections on the management of pediatric emergencies in Belgium]. / Observations et réflexions sur la gestion des urgences pédiatriques en Belgique.

Similar to the findings of other nations, inappropriate utilization of the pediatric emergency departments is a major problem in Belgium. The majority of patients come with non-urgent complaints. Maximum rush is seen in the evening when the outpatient clinic is closed. It results in a waste of resources, stress among the emergency room staff and an increase in waiting time for patients requiring attention. It appears important to adapt to this new situation by improving the organisation of the pediatric emergency departments (triage, human resources, equipment), but also by finding alternative solutions such as health education of families and greater availability of primary care providers. This article describes the present situation and evaluates strategies that could be applied in Belgium.

[Thibaut, age 14, suffers from polyarthralgias]. / Thibaut, 14 ans, se plaint de douleurs articulaires.

We describe the medical history and diagnostic difficulties in a 14 year-old boy who presented with "polyarthralgias".

[Jeremy, age 6 and one-half months, consulting for hypotrophy]. / Jeremy, 6 mois et demi, consulte pour hypotrophie.

This is the medical history of a 6 month old baby who suffers from retarded weight gain. The difficulties encountered in establishing the diagnosis are outlined.

[Persistent fever in a 10-year-old girl]. / Fièvre persistante chez une fille de 10 ans.

We describe the case of a 10 year-old adopted girl who presented with persistent fever, recurrent moderate infections and failure to thrive. HIV infection was finally diagnosed. She dramatically improved with highly active antiretroviral therapy.

[Preventive cardiology: strategies in children]. / La cardiologie préventive: stratégies chez l'enfant.

The importance of preventive cardiology in youth has been established by several critical observations: there is evidence that the atherogenic process begins in childhood, and that the degree of atherogenesis is related to measurable risk factors present during childhood. The literature indicated that long-range prevention of atheroselerosis and its sequelae by control of those risk factors should begin in childhood. This article reviews the established risk factors, the identification of high-risk individuals, public health strategies for the promotion of health in the French Community of Belgium and treatment of high-risk individuals.