[Recommendations for pediatric oxygen therapy in acute and chronic settings: Needs assessment, implementation criteria, prescription practices and follow-up]. / Recommandations pour l'oxygénothérapie chez l'enfant en situations aiguës et chroniques : évaluation du besoin, critères de mise en route, modalités de prescriptions et de surveillance.

Recommendations for acute and long-term oxygen therapy (needs assessment, implementation criteria, prescription practices, and follow-up) in children were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP2A). The Haute Autorité de Santé (HAS) methodology, based on the Formalized Consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text (arguments+recommendations) is available at the website of the French Paediatric Society: www.sfpediatrie.com.

[Recommendations for pediatric oxygen therapy in acute and chronic settings: needs assessment, implementation criteria, prescription practices and follow-up]. / Recommandations pour l'oxygénothérapie chez l'enfant en situations aiguës et chroniques : évaluation du besoin, critères de mise en route, modalités de prescription et de surveillance.

Recommendations for acute and long-term oxygen therapy (needs assessment, implementation criteria, prescription practices, and follow-up) in children were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP2A). The Haute Autorité de Santé (HAS) methodology, based on the Formalized Consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text (arguments+recommendations) is available at the website of the French Paediatric Society: www.sfpediatrie.com.

[Severe hydrogen sulfide intoxication: a pediatric case of survival]. / Intoxication accidentelle grave à l'hydrogène sulfuré: un cas pédiatrique de survie.

We report a paediatric case of survival following severe hydrogen sulfide (H2S) gas intoxication. A 13-year-old boy was found submerged to the neck in a manure tank. He was hypothermic, unresponsive with bilateral mydriasis, and had poor oxygen saturation. After intubation, he was transferred to the paediatric intensive care unit of a tertiary care children's hospital. He developed acute respiratory distress syndrome (ARDS) requiring high frequency percussive ventilation. Cardiac evaluation was significant for myocardial infarction and left ventricular function impairment. He completely recovered from the respiratory and cardiac failure. Neurological examinations showed abnormal signals on MRI in the semi-oval center and in the frontal cortex. Follow-up detected partial impairment of axonal fibers of the right external popliteal sciatic nerve. Paediatric cases of survival after H2S intoxication have been rarely reported. Such exposures can evolve to severe ARDS and benefit from high frequency percussive ventilation. Hypothermia and other metabolic abnormalities are now better explained thanks to actual knowledge about endogenous H2S function. Lessons learned from paediatric accidents should result in better information about this threat for farmers and families living in houses with septic tanks, reducing the risk to their own and their children's safety.

[Pulmonary sequestration and enteric cyst, 2 expressions of the same abnormality]. / Séquestration pulmonaire et kyste entérique, 2 expressions d'une même anomalie. Illustration par un cas.

We report the case of an 18-month-old boy operated on for a right lower lobe bronchopulmonary sequestration. At the immediate postoperative check-up, a septic right thoracic effusion appeared, connected to a cystic mediastinal retrocrural formation on CT. After a drainage attempt and medical therapy, the abdominal lesion was resected. Histological examination showed that the cyst cavity was lined with pseudostratified non-ciliated epithelium, without cartilage, consistent with an enteric cyst. Regardless of the embryological theory, a literature review confirmed that in presence of one of these two lesions, one should systematically look for the other.

[A rare association of double discordance with aortic arch anomalies: value of multislice CT scan]. / Association exceptionnelle d'une double discordance avec anomalie des arcs aortiques: apport du scanner multicoupe.

The authors report the case of a 14 month old infant admitted for intermittent stridor. Routine echocardiography showed atrioventricular and ventriculo-arterial discordance with an intact septum and situs solitus with levocardia. Multislice CT scan showed tracheal compression due to a Neuhauser anomaly of the aortic arches. The paucity of symptoms led to surgical abstention.

[Relationship between respiratory syncytial virus bronchiolitis and asthma]. / Relations bronchiolite à virus respiratoire syncytial et asthme.

Data of the literature over the last 20 years indicate that infantile asthma, although heterogeneous, often appears following RSV bronchiotitis, especially when sufficiently severe to justify hospitalisation. The risk of developing episodes of wheezing (bronchial obstruction syndrome) over the following 2 to 3 years is higher than 50%, but estimations vary according to the authors. Functional disturbances (pulmonary distension, nonspecific bronchial hypperreactivity, hypoxia), with or without associated clinical symptoms, may be observed several months to several years after hospitalisation for bronchiolitis. On the other hand, mild bronchiolitis, and most of the recurrent expiratory obstructive syndromes with asymptomatic free intervals between episodes do not appear to carry a risk of functional sequelae. Children suffering from severe bronchiolitis usually develop a severe bronchial obstruction syndrome. In asthma, the percentage of IgE-dependent sensitization is less than 20% before the age of 4 years. The presence of positive skin tests and/or specific serum IgE directed against the usual allergens are associated with the persistence of asthma during the childhood. Similarly, the appearance of wheezing after the age of 3 years (or recurrence after this age) is associated with the persistence of asthma. Prospective studies of cohorts followed since birth show that pre-existing functional abnormalities can promote the appearance of bronchiolitis and bronchial obstruction syndrome. Asthma in infants comprises several phenotypes with very different prognoses.

[Prognosis of asthmatic adolescents in adulthood]. / Pronostic à l'âge adulte de l'asthme de l'adolescent.

Little is known about the long-term outcome of asthmatic adolescents. According to the literature, 20 to 50% of asthmatic adolescents become symptom-free when they become adults. We report 50 cases of asthmatic adolescents, 25 girls and 25 boys, with a mean follow of 4.4 years (range 1-12 years). Only 4 patients (8%) became symptom-free, all 4 were stage I and II patients. One death occurred subsequent to penicillin allergy, but was not related to status asthmaticus. Nor remission was observed in stage III and IV patients, whereas 5.8% and 12% of stage II and II patients respectively grew out of their asthma. The factors predictive of persistent asthma in adulthood were severe asthma at the age of 13 years, female gender, onset of asthma before the age of 7 years, no periodic rhinitis, and exercise induced asthma.

[New food allergies]. / Les nouveaux allergènes alimentaires.

RISING INCIDENCE OF FOOD ALLERGIES: Food allergies are becoming more and more common, concerning 3 to 4% of the general population. One out of four persons allergic to nuts, the most frequent food allergen, have severe signs and symptoms. A CLASSICAL DIAGNOSIS: Certain diagnosis of food allergy is established on the basis of labial and oral tests. The dose required to induce a reaction is established by the oral test, giving information about the severity of the allergy and its progression. OTHER ALLERGENS: "Emerging" food allergens include spices and condiments, exotic fruits (kiwi, avocado, cashew and pecan nuts, Brazil nuts), sesame seeds, psyllium, sunflower seeds. Endurance exercise following ingestion of a food allergen can lead to severe anaphylactic reactions. Allergen associations "food-pollen", "latex-food", "mitessnails" have been described. INDISPENSABLE PREVENTION: Avoiding contact is essential. Many allergens are "masked" within prepared foods. Precise labeling, with particular attention to nut content, must be reinforced. Individualized counseling on food allergies should be available for school children. Persons with severe allergies should keep at hand an emergency kit with antihistamines, injectable rapid action corticoids and adrenalin (1 mg/ml).

[Allergic bronchopulmonary aspergillosis in children]. / Aspergillose bronchopulmonaire allergique chez l'enfant.

Allergic bronchopulmonary aspergillosis (ABPA) associates the development of aspergillus in bronchus and a predominant immediate hypersensitivity for aspergillus antigens. It complicates an old and severe allergic asthma or cystic fibrosis. Its prevalence is not well known. In children, ABPA prevalence is rare, except in cystic fibrosis where 0.6% to 11% of patients can be affected by the disease. Acute exacerbation of the disease favours the development of bronchiectasis and fibrosis. The diagnosis is suggested by an unexplained aggravation of asthma or, in cystic fibrosis, by wheezing, an unsuccessful antibiotherapy, and a recent modification of the chest X-ray. The diagnosis is based upon the presence of seven major criteria or six major criteria and one minor. The follow-up of biological parameters is important for early diagnosis of exacerbations. Some parameters are very sensitive, ie, precipitins and total serum IgE. Systemic corticotherapy is the usual treatment of exacerbation. The association with inhaled corticotherapy could reduce the duration of systemic treatment. The use of Itraconazole is logical, mainly in cystic fibrosis.

[Penicillin-resistant pneumococcal pneumonia (serotype p14), and coinfection with respiratory syncytial virus and Mycoplasma]. / Pleuro-pneumopathie à pneumocoque résistant à la pénicilline (sérotype p14), et co-infection à virus respiratoire syncytial et mycoplasme.

A 3-year old child was admitted for a pneumococcal pneumonia with pleural effusion, initially treated with amoxicillin and clavulanic acid. Clinical deterioration suggested a resistance to conventional antibiotics which was confirmed by bacteriological investigation. A co-infection with respiratory syncitial virus and Mycoplasma pneumoniae was associated. Under adapted antibiotherapy, the clinical course improved.

[Turner's syndrome and isoforms of LH and FSH. Value of polyclonal enzymatic techniques]. / Syndrome de Turner et isoformes de LH et FSH. Intérêt des techniques enzymatiques polyclonales.

BACKGROUND: The glycoproteic hormones, LH and FSH, circulate under heterogenous molecular forms, the isoforms. The more acidic isoforms of FSH are found in hypogonadic patients and a displacement towards the basic forms is observed during substitutive treatment. CASE REPORT: A 13 year-old girl with Turner syndrome was examined for pubertal delay. Ultrasonography failed to see both ovaries and endocrine investigations showed a type P1 response (LH-RH test using immunological method). Control of hormonal levels by a polyclonal immunoenzymatic method confirmed primary hypogonadism. CONCLUSIONS: Radioimmunological methods using monoclonal antibodies can underevaluate FSH and LH levels under circumstances in which the distribution of isoforms may vary. Discrepancy must lead to the measure of gonadotrophins using polyclonal immunoenzymatic methods.