[Covid-19 and adolescence: Clinical findings and psychopathological thoughts about some immediate or differed impacts]. / Covid-19 et adolescence : constats cliniques et réflexions psychopathologiques à propos de quelques incidences immédiates ou différées.

This pandemic has profoundly changed our lives for many months and its long-term consequences remain largely hypothetical. The containment measures, the threats to the health of relatives, the constraints limiting social openings have left no one indifferent, but may have particularly impeded "adolescent separation work". Most of adolescents have been able to deploy their adaptation capacities, while for others this exceptional situation has triggered stressful reactions for those around them. Some were immediately overwhelmed by the direct or indirect manifestations of their anxiety or by their intolerance of governmental instructions, others revealed their difficulties only when the schools reopened, or even in the distant "aftermath", as shown by some studies carried out at a distance revealing a clear increase in suicidal ideation. We will not be surprised by the problems of adaptation of the most fragile, of those suffering from psychopathological disorders, but it is necessary to note an increase in the needs for psychological care. Teams dealing with the suffering of adolescents are puzzled by the increase in self-vulnerable acts, anxious school refusals, eating disorders or various forms of addiction to screens. However, everyone agrees on the key role of parents and the impact of their own suffering on that of their children, even if they are young adults. Of course, it is important that caregivers do not forget the parents in the support they aim to provide to their young patients.

[Perception of adolescent medicine among French pediatric residents]. / Représentations de la médecine de l'adolescent chez les futurs pédiatres.

PURPOSE: The perception of adolescent medicine (AM) among future pediatricians in France has scarcely been explored although adolescent health care is an integral part of the pediatrician's job. Moreover, pediatric residents seem to have a lack of enthusiasm for this field. The aim of this study was to assess the beliefs and perceptions of fourth-year French pediatric residents regarding adolescents and AM. METHODOLOGY: We conducted a national electronic survey among French pediatric residents in their last year of residency. An original 51-item, open-ended declarative questionnaire was sent out including questions on demographics, career expectations, AM block rotation experiences, and perceptions and beliefs regarding adolescents and AM. Difficulties and barriers experienced in this field were investigated. Queries about residents' specific AM courses and about their educational needs were also explored. RESULTS: The survey was conducted online between January and March 2015. There were 121 respondents, achieving a 43% response rate. The majority of respondents perceived teens as interesting (75%), vulnerable (83%), and time-consuming (84%). Up to four fifths of respondents (81%) considered AM to be a skill that all pediatricians should acquire. A subgroup analysis showed that the residents who had not experienced an AM block rotation did not seem to be convinced of the need for training in this field (P=0.09). The following issues were reported as major difficulties by residents: providing care for teens reluctant to seek health care (65%), managing violent behavior among adolescents in the emergency ward (98%), and managing adolescents who attempt suicide (80%). Less than half (45%) of the residents reported their residency program had a specific AM course. Among them, 73% attended the lectures and 57% found them useful. One third (32%) of the respondents had experienced a 2-month block rotation in the field of AM during their residency. DISCUSSION: This is the first nationwide study in France in this field. Although the response rate is below 50%, it exceeded our expectations. Our results are in line with previous studies showing that pediatric residents report a high interest in working with adolescents and yet their educational needs in AM are unmet. The limitations of this study include the self-selection bias and implicit limitations carried by the phrasing of the survey questions. CONCLUSIONS: There is a need to devise a better educational approach combining a broader proposal of AM block rotations together with a specific competency framework in adolescent health, since we know it improves the quality of health care delivered to adolescents. Moreover, training pediatricians in AM is a public health priority so as to comply with medical schools' principles of social accountability and address the priority health needs for an efficient, equitable, and sustainable health system. At a time when postgraduate reform is being made, the inclusion of an AM curriculum in the general pediatrician course is necessary.

[Chronic intestinal pseudo-obstruction complicated by an eating disorder]. / Pseudo-obstruction intestinale chronique compliquée d'un trouble des conduites alimentaires chez une adolescente.

Chronic idiopathic intestinal pseudo-obstruction is a rare and serious chronic disease starting in childhood, which can affect the entire digestive tract. It is caused by a peristalsis intestinal disorder that leads to occlusions without any obvious obstruction. Few studies have been carried out regarding the prognosis of this illness. This disease is often diagnosed by a process of elimination, but some histological anomalies have been present in the digestive wall of certain patients. This clinical case concerns a 17-year-old girl affected by CIPO and eating disorders. It seems difficult to discriminate between digestive disorders and eating disorders. What psychological effects can this severe pathology have? Are eating disorders induced by CIPO? These questions are raised in this article through the example of this patient's somatopsychic complexity and the ensuing difficulties in her overall care.

[Does insulin pump therapy improve quality of life and satisfaction in children and adolescents with type 1 diabetes?]. / La pompe à insuline améliore-t-elle la qualité de vie et la satisfaction des enfants et adolescents diabétiques de type 1 ?

Insulin pumps are booming in pediatric diabetology. The objective of this study was to assess changes for children and adolescents with type 1 diabetes using a pump in terms of quality of life (QOL), satisfaction, and glycosylated hemoglobin. A retrospective self-evaluation questionnaire was distributed to 41 patients. It focused on general QOL, diabetes-specific QOL supplemented by specific questions on the pump, and satisfaction. Clinical and biological parameters (glycated hemoglobin: HbA1c) were compared before and after pump use. The score for QOL with the pump was positive, more so if started early after diagnosis of diabetes (P=0.03) and with children under the age of 8 years (P<0.02). These positive results are mainly related to the characteristics of the pump, "insulin management" and "injections," as well as "diabetes management," "behavior," "school," "family life," "daily life," and "physical activities." On the other hand, the improvement was not significant for the item "life in society, friends and family." A decrease in the number of injections and the flexibility of meals were the most positive points. HbA1c improved as soon as the pump was indicated before its use was begun (P=0.005) and remained constant for 4 years (P≤0.05). Forgotten injections, comments on diabetes, and technical problems appeared to be exceptional. The pump changed the patient's body image because of ambivalent feelings between being normal (greater freedom) and different (visibility and a reminder of the disease). The benefits in terms of QOL and glycemic control with the pump cannot be dissociated and can only be considered accompanied by paramedical and medical assistance. Improving QOL over the short and long term by reducing the risk of further complications is the daily challenge of families and diabetologists.

Another case of idiopathic megaesophagus in a girl with growth hormone deficiency.

BACKGROUND: Achalasia or idiopathic megaesophagus is rare in children, and an association with growth hormone (GH) deficiency has rarely been described. CASE REPORT: This report is of a girl treated with recombinant GH (rGH) for isolated GH deficiency who simultaneously presented with idiopathic megaesophagus. CONCLUSION: This case report highlights the fact that practitioners need to be aware of this possible morbid association.

[Cystinuria in children: A report of 4 cases]. / Cystinurie chez l'enfant : à propos de 4 observations.

Cystinuria is an inherited autosomal-recessive disorder of renal reabsorption of the dibasic amino acids. It is the cause of about 6% of all kidney stones observed in children. Cystine is relatively insoluble at the physiological pH of urine. Cystine stones are characteristic and frequent recurrences are observed. We report on 4 cases and describe the initial presentation (obstructive renal failure, urinary sepsis, familial screening) and the medical and surgical management. Medical management is mainly based on hyperhydration and urine alkalinization. Long-term therapy with sulfhydryl agents to prevent formation of renal stones seems to be effective but adverse side effects are frequent, requiring the withdrawal of treatment. Urological management has evolved from surgical stone removal to minimally invasive procedures (extracorporeal shock wave lithotripsy, ureteroscopy).

[Prospective study at 1 week of life of thyroid function in 97 consecutive pre-term newborns under 32 weeks of gestation]. / Étude prospective à une semaine de vie de la fonction thyroïdienne chez 97 prématurés consécutifs de terme inférieur à 32 semaines d'aménorrhée.

UNLABELLED: Hypothyroxinemia of prematurity (HTOP) is associated with neurodevelopmental impairment in pre-term newborns born at less than 32 weeks of gestation (WG). HTOP is not clearly defined in the literature and there is no consensus on whether or not treatment of HTOP is beneficial. OBJECTIVE: To describe the epidemiologic characteristics of HTOP and to determine the population at risk of HTOP. POPULATION AND METHODS: Ninety-seven pre-term newborns under 32 WG were prospectively included in this study. FT4 and thyroid-stimulating hormone (TSH) serum levels were assessed between day of life 5 and 7. HTOP was defined as serum level of FT4 0.80 ng/dl or less and TSH less than 20 mUI/l. RESULTS: The HTOP incidence was 29% in pre-term newborns under 32 WG and 64% in pre-term newborns 28 WG or less. FT4 levels were correlated with gestational age (P<0.001). The incidence of hypotension (61% vs 33%; P<0.05), patent ductus arteriosus (50% vs 17%; P<0.05), dopamine treatment (39% vs 16%; P<0.05), and hydrocortisone treatment (25% vs 6%; p<0.05) was higher in the HTOP group. Similarly, severe intracerebral hemorrhage (14% vs 0%; P<0.01) and hypothermic events under 36 °C (1.8 ± 1.7 vs 0.0 ± 0.4; P<0.05) were higher in the HTOP group. CONCLUSION: Incidence of HTOP is high in pre-term newborns born at less than 28 WG. Morbidity during the first week of life is higher in cases of HTOP. Whether or not treatment of all pre-term with l-thyroxin is beneficial is unknown. However, treatment of the subgroup of pre-term newborns under 28 WG with HTOP should be considered.

[Neonatal renal venous thrombosis following an electrical shock in pregnancy]. / Thrombose néonatale de la veine rénale suite à une électrisation in-utero accidentelle.

Neonatal renal venous thrombosis may result in severe morbidity. Predisposing conditions are well known. We report the case of an unusual and early neonatal renal venous thrombosis. The mother received an electrical shock at 34 weeks gestation. This case demonstrates that maternal electrical shock effect on the fetus should be early investigated.

[Adolescent obesity: guidelines for the management]. / Obésité au temps de l'adolescence: repères pour une prise en charge.

The increasing prevalence of adolescent obesity justifies widespread effort and attention of the paediatrician. In order to manage, following points are to be documented: (I) weight status assessed on the basis of body mass index (BMI)split in two levels: obesity grade I: >or=97 ème centile, obesity grade 2: level IOTFC 30; (2) complete anamnesis including age at adiposity rebound and existence of overweight in family; (3) research of associated morbidity and medical risks;(4) assessment of food intake and feeding practice; (5) assessment of physical activity; (6) talk with the adolescent to assess the psychological status, looking after depressive symptoms, anxiety, loss of self esteem. Once the items are documented, it allowed making a plan to manage the obesity in alliance with the adolescent and his family.

[Prevalence of celiac disease markers in a French cohort of children and adolescents with type 1 diabete mellitus]. / Prévalence des marqueurs biologiques de la maladie coeliaque dans une cohorte d'enfants et d'adolescents diabétiques de type I.

The aim of this study was to determine the prevalence of celiac disease (CD) markers in a French cohort of 84 children type 1 diabetics. Detection of antitransglutaminase (AtTG), antiendomysium (AEA) and antigliadin (AGA) antibodies was performed. Group 1 included 81 (96.4%) diabetic patients with negative antibodies. Group 2 included 3 patients (3.6%) with positive serological markers: 1 AGA-AEA-AtTG and 1 AEA-AtTG with proved histological diagnosis and 1 AGA positive with negative histology. No statistically significant difference was observed between the groups with regard to age, duration of diabetes, familial target stature, and ratios Height/Age and Weight/Height. Presence of CD serological markers was related to a lower level of HbA1c. Prevalence of CD serological markers is important in this French cohort but lower than other countries.

[Change in management of ureteropelvic junction obstruction]. / Evolution de la prise en charge du syndrome de la jonction pyélo-urétérale.

PURPOSE: The aim of this study was to evaluate the change in ureteropelvic junction management, from surgical correction to observation of the hydronephrosis. We checked wether or not it was deleterious for kidney. MATERIALS AND METHODS: We retrospectively reviewed 96 charts between 1988 and 1998. Initial ultrasonography, and voiding cystourethrogram were available for all cases. Intravenous urography and diuretic renography were studied when available. Minimal follow-up of patients was one year. Patients were divided into three groups: surgery right away, surgery after observation, and observation only. RESULTS: Later was the diagnosis, more significant were the hydronephrosis and impairment of renal function (p < 0.01). In group operated on right away (69 cases), drainage improved, hydronephrosis decreased, but renal function did not improve significantly (p = 0.37). Sixteen patients were operated on after observation without deleterious effect for kidney. Eleven patients were only observed: hydronephrosis progressively decreased. Initial radiological results were not different between the last two groups (p > 0.05), and were not predictive of their course. CONCLUSION: Initial non operative management of hydronephrosis was not dangerous for renal function. It is advisable to detect at the earliest all signs of obstruction, because surgery improves renal drainage but not renal function.

[Central venous access for hemodialysis: use and practice with the child in France]. / Accès veineux centraux pour hémodialyse: usage et pratique chez l'enfant en France.

Central venous catheter (CVC) are being increasingly used as hemodialysis vascular access. In order to evaluate the indications, practice and uses in the pediatric population, we conducted a study in children with renal failure (RF). A questionnaire was sent to the 21 french paediatric hemodialysis centers to inquire population deserved, number, type, site and indications of CVC, procedure of management and attitude towards infection and thrombosis. A prospective survey was added to compile information about CVC during the period 7/2000-31/12/2000. Results (exhaustivity response 80%) showed 1. large diversity in choice of material with predominance of pediatric permcath QUINTON; 2. exclusive surgical insertion for 8 out of 19 centers; 3. rare use of femoral route (never and exceptionally reported, respectively by 4 and 6 centers and predominantly in acute RF; 4. heterogene attitude towards fixing, dressing, heparine locking and procedure of urokinase administration in case of thrombosis, whilst procedure towards infection was homogeneous; 5. indications of insertion of the 31 prospective study CVC were distributed in 4 subgroups a) breakdown of vascular permanent access (6 cases) or of peritoneal dialysis (2 cases), b) unexpected terminal renal failure (6 cases), c) deliberate choice to wait transplantation (4 cases) or to face breakdown of transplantation (4 cases), d) dysfunction of a previous CVC (7 cases); 6. a rate of 20% of dysfunction (flow problem); 7. a rate of replacement of 11%. AVC are effective forms of vascular access. However CVC indications should be carefully analysed and balanced if possible with alternative route such as anticipated creation of arterioveinous fistula, peritoneal dialysis and preemptive transplantation.