L'impact de la COVID-19 sur la santé des enfants, groupe « protégé ¼ de l'infection.

OBJECTIVE: This article underlines that a viral epidemic and strategies to deal with it 1) have a major impact on groups that are a priori spared by the disease itself, in this case children, and 2) can generate health problems beyond the disease and lead to major social, economic and educational difficulties and an increase of social inequalities in health. METHOD: The observations presented are based on the scientific literature available in the first half of 2020 and on discussions with actors in the field, experts and heads of institutions, conducted by a working group of the Haut Conseil de la Santé Publique reflecting on a global and concerted policy for children's health. RESULTS: The health crisis and its management have had an impact on children's development and their quality of life. They have been more exposed to sedentary lifestyles, screens, accidents, and violence at home. The closure of schools and leisure facilities has led to difficulties in school, socialization, psychological well-being and mental health. Curative or preventive care has been postponed. These effects occurred with significant social and territorial inequalities. CONCLUSION: Any health crisis management requires an assessment of the overall impact of the epidemic and the proposed measures on health, economic, social, and educational indicators. This crisis shows the need for a coordinated children's policy, which is not currently the case in France.

A Frosty Challenge.

BACKGROUND: We report a case of geometrical skin lesions in a teenage patient. CASE: A previously healthy 14-year-old boy presented in our pediatric emergency department with unusual skin lesions on his left forearm. The patient said the lesions started 2 weeks earlier following a spider bite. His physical examination revealed an otherwise healthy child with no medical history with raised square lesions of the left forearm. The lesions were in different stages of healing and resembled second-degree burns. Examination showed no other lesions. Vital signs were normal. The patient was discharged after the lesions were dressed with antibiotic ointment. A follow-up consultation was scheduled a week later, but the patient did not attend the follow-up consultation. A senior emergency physician called the family and learned that the lesions were progressively healing and no other lesions appeared. The teen admitted he played the "salt and ice challenge." DISCUSSION: The salt and ice challenge involves putting salt on the skin and then applying and/or pressing ice cubes on top of the salt. The challenge is to resist the pain consecutive to frostbite for as long as possible. The result is often second-degree burns and possible partial third-degree burns. CONCLUSIONS: Because of the current popularity of this practice, emergency or family physicians, pediatricians, dermatologists, and burn or orthopedic surgery units might encounter these injuries. When young patients present with geometrical burn injuries and unexplained or bizarre circumstances, self-inflicted burn "challenges" should be considered.

Troubles mictionnels et accès aux toilettes chez les enfants scolarisés : enquête dans l'Académie de Toulouse.

Not urinating regularly, voluntarily restraining oneself at school promotes the occurrence of voiding disorders. AIM: To determine the prevalence of such disorders in elementary schools (students from 1st to 5th grade) and analyze the role of access to school toilets on voiding habits. METHOD: Observational, descriptive epidemiological study during the 2017-2018 school year by electronic questionnaire with parents of pupils attending elementary school. RESULTS: 2119 questionnaires were analyzed. The graders sex ratio was 1.07 (1087 boys). 410 families (19%) were classified as "popular" class. First, second and third graders represented 60% of the enrollment (N = 1273). Overall use of school toilets was 87% and 69% of students had appropriate use for urine. The main obstacles to their use were lack of hygiene and comfort (51%), lack of security or privacy (33%), limited accessibility (28%). The overall prevalence of urinary elimination disorders was 9%. Girls had more inappropriate use of the toilet for urine (36% vs 27%, OR 1.5, P = 0.0004). The factors associated with urinary elimination disorders were: not using the toilet (13% vs 9 %, OR 1.5, P = 0.04), being a girl (14% vs 5%, OR 3.5, P < 0.0001), belonging to the working class (14% vs 8% OR 1.8, P = 0.0008). CONCLUSION: This situation, which is a long-denounced major public health problem, mainly affects girls and also reveals social inequalities in the use of school toilets.

[Voiding dysfunction and access to toilets among elementary school children: A Toulouse school district study]. / Troubles mictionnels et accès aux toilettes chez les enfants scolarisés : enquête dans l'Académie de Toulouse.

Not urinating regularly, voluntarily restraining oneself at school promotes the occurrence of voiding disorders. AIM: To determine the prevalence of such disorders in elementary schools (students from 1st to 5th grade) and analyze the role of access to school toilets on voiding habits. METHOD: Observational, descriptive epidemiological study during the 2017-2018 school year by electronic questionnaire with parents of pupils attending elementary school. RESULTS: 2119 questionnaires were analyzed. The graders sex ratio was 1.07 (1087 boys). 410 families (19%) were classified as "popular" class. First, second and third graders represented 60% of the enrollment (N = 1273). Overall use of school toilets was 87% and 69% of students had appropriate use for urine. The main obstacles to their use were lack of hygiene and comfort (51%), lack of security or privacy (33%), limited accessibility (28%). The overall prevalence of urinary elimination disorders was 9%. Girls had more inappropriate use of the toilet for urine (36% vs 27%, OR 1.5, P = 0.0004). The factors associated with urinary elimination disorders were: not using the toilet (13% vs 9 %, OR 1.5, P = 0.04), being a girl (14% vs 5%, OR 3.5, P < 0.0001), belonging to the working class (14% vs 8% OR 1.8, P = 0.0008). CONCLUSION: This situation, which is a long-denounced major public health problem, mainly affects girls and also reveals social inequalities in the use of school toilets.

A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach?

Pediatricians working in an emergency environment are confronted with children admitted to emergency departments for intoxication on a daily basis. We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014. Twenty-nine children under the age of 3 were admitted with a positive cannabis urine test. Eighty-seven percent of intoxications occurred at the family home. Resin was the main form of ingested cannabis (69%). The mean age was 16.5 ± 5.2 months, and mean weight was 11.1 ± 2.1 Kg. Sixty percent of admissions occurred between 2012 and 2014. More severe presentations, based on Poisoning Severity Score, occurred over the past 2 years. Four children experienced seizures before admission. Ten children (34%) had a decreased level of consciousness (GCS <12) and were admitted to a pediatric intensive care unit for 12-24 h. All of them had ingested hashish (resin). The majority (70%) of children suffering from neurological impairment were admitted in the last year, of whom three required assisted ventilation. There were no cases with major outcomes and no deaths. Parents were not assessed regarding their cannabis consumption. CONCLUSION: This study supports the impression that accidental child poisonings with cannabis have been more serious than previously thought for 2 years. This observation may be explained by (1) the increased THC concentration in cannabis and (2) the widespread use in young adults, even after they become parents. Introducing an addiction team inside the PED could help to improve the care links with these parents. What is Known: • Cases of unintentional cannabis intoxication in children have been increasing for many years due to an increase of potency. What is New: • We highlight an increase in more severe presentations in children under the age of 3 occurring over the past 2 years, which will indicate the importance of assessing cannabis abuse in parents by a specialized addiction team.

Cannabis Hyperemesis Syndrome in the Emergency Department: How Can a Specialized Addiction Team Be Useful? A Pilot Study.

BACKGROUND: Chronic cannabis users may experience cyclical episodes of nausea and vomiting and learned behavior of hot bathing. This clinical condition, known as cannabis hyperemesis syndrome, was first reported in 2004. OBJECTIVE: Our aim was to promote early recognition of this syndrome in emergency departments (EDs) and to increase referral to addiction specialists. METHODS: Cannabis abusers were admitted to the ED for vomiting or abdominal pain from June 1, 2014 to January 1, 2015 and diagnosed with cannabis hyperemesis syndrome by a specialized addiction team. Then, medical records were examined retrospectively. RESULTS: Seven young adults were included. Their mean age was 24.7 years (range 17-39 years) and the majority were men (male-to-female ratio 1.2). Biological and toxicological blood samples were taken in all patients. Tetrahydrocannabinol blood level was measured in 4 patients, with a mean blood concentration of 11.6 ng/mL. Radiographic examination including abdominal computed tomography and brain imaging were negative, as was upper endoscopy. Five patients compulsively took hot baths in an attempt to decrease the symptoms. Treatment was symptomatic. Five patients have started follow-up with the specialized addiction team. CONCLUSIONS: Cannabis hyperemesis syndrome is still under-diagnosed 10 years after it was first described. Physicians should be aware of this syndrome to avoid repeated hospitalizations or esophageal complications. Greater awareness should lead to prompt treatment and prevention of future recurrence through cannabis cessation. Addiction specialists, as well as medical toxicologists, are experts in the management of cannabis abusers and can help re-establish the role of medical care in this population in collaboration with emergency physicians.

Minoxidil topical solution: an unsafe product for children.

Minoxidil hair formulation is commonly used for the treatment of male or female androgenic alopecia. This over-the-counter product is wrongly considered safe. The ingestion of a few milliliters by a child can lead to significant intoxication. We report a case of significant intoxication after the ingestion of topical minoxidil (Alopexy; Pierre Fabre Laboratoires, SA, Switzerland). A 7-year-old girl, who accidentally ingested a teaspoon of minoxidil hair solution, presented to the pediatric emergency department for emesis. At admission, she had a blood pressure of 86/56 mm Hg and a pulse of 149 beats per minute. Hypotension lasted 40 hours with the lowest value 24 hours after ingestion (79/33 mm Hg). She presented electrocardiogram changes (sinus tachycardia and flattening T-waves) but normal cardiac enzymes. Infusion of 20 mL/kg of normal saline fluid had no hemodynamic effect. Her blood pressure normalized on day 2. Minoxidil topical solution is an unsafe product for children. This formulation should be strictly kept out of reach of children and manufacturers should enhance child-resistance security of packaging. The over-the-counter availability must be questioned.

Parental cannabis abuse and accidental intoxications in children: prevention by detecting neglectful situations and at-risk families.

OBJECTIVES: Cannabis intoxication in toddlers is rare and mostly accidental. Our objectives were to focus on the characteristics and management of children under the age of 6 years who were admitted to our emergency department with cannabis poisoning reported as accidental by parents, and to point out the need to consider accidental cannabis ingestions as an indicator of neglect. METHODS: The medical records of children hospitalized for cannabis poisoning in a pediatric emergency department from January 2007 to November 2012 were retrospectively evaluated. Data collected included age, sex, drug ingested, source of drug, intentional versus accidental ingestion, pediatric intensive care unit or hospital admission, treatment and length of hospital stay, toxicology results, and rate of child protectives services referral. RESULTS: Twelve toddlers (4 boys and 8 girls; mean age, 16.6 months) were included. All had ingested cannabis. Their parents reported the ingestion. Seven children experienced drowsiness or hypotonia. Three children were given activated charcoal. Blood screening for cannabinoids, performed in 2 cases, was negative in both, and urine samples were positive in 7 children (70%). All children had favorable outcomes after being hospitalized from 2 to 48 hours. Nine children were referred to social services for further assessment before discharge. CONCLUSIONS: Cannabis intoxication in children should be reported to child protection services with the aim of prevention, to detect situations of neglect and at-risk families. Legal action against the parents may be considered. Accidental intoxication and caring parents should be no exception to this rule.

Necrotizing pneumonia in children: Report of 25 cases between 2008 and 2018 at a French tertiary care center.

BACKGROUND: Necrotizing pneumonia (NP) is a serious and rare disease in children. Pediatric data on NP are limited and the impact of the 13-valent pneumococcal conjugate vaccine has been very poorly evaluated. PATIENTS AND METHODS: We conducted a retrospective study at Toulouse University Hospital between 2008 and 2018. Children who presented with thin-walled cavities in the areas of parenchymal consolidation on imaging were included in the study. RESULTS: The incidence of NP did not decrease during this period. Bacterial identification occurred in 56% of cases (14/25) and included six cases of Streptococcus pneumoniae, five of Staphylococcus aureus, two of Streptococcus pyogenes, and one of Streptococcus viridans. Streptococcus pneumoniae NP are more frequently associated with empyema/parapneumonic effusion compared to S. aureus NP (p = 0.02). Patients with S. pyogenes NP more often required volume expansion than did S. pneumoniae cases (p = 0.03). When comparing children born before and after implementation of the 13-valent pneumococcal conjugate vaccine, we identified a relative modification of the bacterial epidemiology, with an increase in the proportion of S. pyogenes NP and S. aureus NP and a decrease in the proportion of NP caused by S. pneumoniae. CONCLUSION: Future studies are needed to assess the epidemiology of NP in children. Continued surveillance of identified pneumococcal serotypes is essential to document epidemiological changes in the coming years.

Non-operative treatment of acute appendicitis in children: clinical efficacy of amoxicillin-clavulanic acid in a retrospective single-centre study.

BACKGROUND: The success rate of non-operative treatment (NOT) of acute uncomplicated appendicitis (AUA) in children varies from 65% to 95%. There are no recommendations on the appropriate antibiotic therapy. OBJECTIVE: To determine the clinical efficacy of amoxicillin-clavulanic acid for NOT of AUA in children. METHODS: Design: Cross-sectional study in a single medical centre. SETTINGS: Emergency department and Paediatric Visceral Surgery department of the Children Hospital in Toulouse, France. PATIENTS: Patients 5-15 years old who were diagnosed with appendicitis, (1) With abdominal pain and a first episode of acute appendicitis, (2) With no radiological or ultrasound evidence of appendicolith, appendiceal perforation, pelvic abscess nor peritonitis, and (3) With non-septic general aspect, were included. INTERVENTIONS: NOT consisted of hospital admission. The antibiotic treatment was a combination of amoxicillin and clavulanic acid (80 mg/kg/day of amoxicillin): intravenous regimen during 48 hours followed by oral route during 7 days. MAIN OUTCOME MEASURE: Success rate of amoxicillin-clavulanic acid NOT in children with AUA at 2 years. RESULTS: The initial success rate of amoxicillin-clavulanic acid NOT in children with AUA was 100% (104/104 patients). The success rate at 2 years was 85.6% (89/104) at discharge. None of the 15 patients who underwent surgery after recurrence of appendicitis presented with peritonitis, appendiceal perforation nor pelvic abscess. CONCLUSION: Narrowed antibiotic therapy with amoxicillin and clavulanic acid seems to be an alternative to surgery in children with AUA. It is necessary to wait for the results of ongoing studies to confirm these results.

A French study of cocaine intoxication/exposure in children (2010-2020).

BACKGROUND AND OBJECTIVE: In the European Union, the record of cocaine-related seizures indicates an expanding supply. The purity has also been increasing. The health impact of these trends remains poorly documented, in particular, the changes and clinical manifestations of intoxication in young children. We attempted to evaluate the trend in French pediatric admissions for cocaine intoxication/exposure over an 11-year period (2010-2020). METHODS: A retrospective, national, multicenter, study of a pediatric cohort. All children less than 15 years of age admitted to a tertiary-level pediatric emergency unit for proven cocaine intoxication (compatible symptoms and positive toxicological screening) during the reference period were included. RESULTS: Seventy-four children were included. Forty-six percent were less than 6 years old. Annual admissions increased by a factor of 8 over 11 years (+700%) and 57% of all cases were admitted in the last two years. The main clinical signs were neurologic (59%) followed by cardiovascular symptoms (34%). Twelve patients were transferred to the pediatric intensive care unit. Factors significantly associated with the risk of being transferred to the pediatric intensive care unit were initial admission to the pediatric resuscitation area (P < 0.001), respiratory impairment (P < 0.01), mydriasis (P < 0.01), cardiovascular symptoms (P = 0.014), age of less than 2 years (P = 0.014). Blood and/or urine toxicological screening isolated eighteen other substances besides cocaine in 46 children (66%). CONCLUSION: Children are collateral victims of the changing trends in cocaine availability, use and purity. Admissions of intoxicated children to pediatric emergency departments are more frequent and there is an increase in severe presentations. Therefore, this is a growing public health concern.

Risk factors for high-grade envenomations after French viper bites in children.

BACKGROUND: Viper bites and subsequent evolution to severe envenomations are more frequent in children. AIM: The aims of this study were to describe the clinical, biological, and therapeutic characteristics of children bitten by vipers in France and to identify risk factors associated with severe envenomations. METHODS: A retrospective study was conducted between 2001 and 2009 in the pediatric emergency department of a tertiary-level children hospital. Collected data were age and sex of children; day and time of admission; day, time, and circumstances of the accident; snake identification; bite location; envenomation severity; presence of fang marks; prehospital care; use of specific immunotherapy and associated treatments; length of stay; and hospital course. RESULTS: Fifty-eight children were included (43 boys, 15 girls). The mean age was 7.8 ± 4.1 years. Bites were most often located on the lower extremities (77%). The classification of envenomation was: 83% low grade (absence or minor envenomation) and 17% high-grade (moderate to severe envenomations). All high-grade envenomations received specific immunotherapy (Viperfav). Being bitten on an upper extremity (P < 0.001), during the afternoon (P = 0.025), feeling violent pain (P = 0.037), and high initial glucose level (P = 0.016) were associated with a significant risk of high-grade envenomation. In the multivariate analysis, 3 factors remained significant: upper-extremity location (relative risk [RR], 60.5 [3.5-1040]; P = 0.005), immediate violent pain (RR, 21.5 [1.3-364.5]; P = 0.03), and female sex (RR, 17.5 [0.9-320.3]; P = 0.053). CONCLUSIONS: A certain number of criteria seem related to more significant risk of progression to high-grade envenomation. Bites to the upper extremities should be carefully observed because of the risk of evolution to a high-grade envenomation.

Influenza A(H1N1)-associated ischemic stroke in a 9-month-old child.

AIM: This study aimed to report a rare clinical course of pandemic influenza A(H1N1) infection, ischemic stroke, in a 9 month-old child. CASE: A 9-month-old girl with no previous medical problem presented to our pediatric emergency department with high fever (39°C/102°F) lasting for 48 hours. Soon after admission, she started generalized tonic-clonic seizures that ceased after 2 injections of diazepam. Six hours later, she presented 2 short episodes of partial clonic seizures of the right arm followed by monoplegia. Lumbar puncture was normal. Noncontrast computed tomographic imaging of the brain was performed and revealed an acute infarct in the left middle cerebral artery territory with no mass effect. Electroencephalogram revealed important slowing in the left hemisphere. A magnetic resonance imaging was performed the next day and confirmed an ischemic stroke in the left posterior middle cerebral artery region. Nasal swab polymerase chain reaction was positive for influenza A(H1N1) and polymerase chain reaction detection negative in cerebrospinal fluid. She fully recovered her right-arm function on day 3 and was discharged on day 10 without sequelae. COMMENTS: Seasonal influenza is known to cause neurological complications in children. Influenza increases the stroke risk especially in adults at high risk. This is a rare event in childhood, and we believe this is the first report associated with H1N1 new variant. CONCLUSIONS: Acute viral infection, notably influenza, is associated with increased susceptibility to stroke, and vaccination against influenza may reduce the risk of stroke.

Prevalence and prediction of PTSD and depression in mothers of children surviving a motor vehicle crash.

Introduction: Few studies have examined the psychopathological consequences for parents of children who were survivors of a motor vehicle crash (MVC). This study assessed the impact of dissociation and peritraumatic distress on the severity of PTSD and post-traumatic major depressive episode (MDE) symptoms in mothers during the first years after the MVC and the role that cortisol response might play in this association. Methods: 125 mothers were included. Peritraumatic distress and dissociation were assessed. Morning salivary cortisol was tested at the baseline. Participants were assessed for a probable diagnosis of PTSD and MDE at 5 weeks, 6 months and 12 months. Results: At 5 weeks, 12 (13.6%) mothers exhibited probable PTSD. During the first year, the PCL score was higher when the (i) Peritraumatic Distress Inventory (PDI) score increased and (ii) the Peritraumatic Dissociation Experience Questionnaire (PDEQ) score increased. Cortisol levels were lower when the PDI score increased. Conclusion: This is the first study to assess the mothers of MVC survivors for one year following the trauma. We confirm that peritraumatic responses are useful for predicting the severity of PTSD symptoms. These results could encourage the implementation of follow-up programmes not only for survivors but also for their mothers. HIGHLIGHTS Mothers of children involved in motor vehicle accident are at risk for developing PTSD.Peritraumatic responses (distress and dissociation) are associated to the severity of PTSD symptoms.Low salivary cortisol levels were associated with high peritraumatic distress.

Antecedentes: Pocos estudios han examinado las consecuencias psicopatológicas para los padres de niños que fueron sobrevivientes de un accidente automovilístico (MVC, por sus siglas en inglés).Objetivo: Este estudio evaluó el impacto de la disociación y la angustia peritraumática en la gravedad del TEPT y los síntomas del episodio depresivo mayor (EDM) postraumático en las madres durante los primeros años después del MVC y el papel que podría desempeñar la respuesta del cortisol en esta asociación.Métodos: Se incluyeron 125 madres. Se evaluó la angustia peritraumática y la disociación. El cortisol salival matutino se analizó al inicio del estudio. Los participantes fueron evaluados para un diagnóstico probable de TEPT y EDM a las 5 semanas, 6 meses y 12 meses.Resultados: A las 5 semanas, 12 (13,6%) madres exhibieron TEPT probable. Durante el primer año, la puntuación PCL (lista de chequeo para TEPT) fue mayor cuando i) aumentó la puntuación del Inventario de angustia peritraumática (PDI, por sus siglas en inglés) y ii) aumentó la puntuación del Cuestionario de experiencias de disociación peritraumática (PDEQ, por sus siglas en inglés). Los niveles de cortisol fueron más bajos cuando aumentó la puntuación PDI.Conclusión: Este es el primer estudio que evalúa a las madres de sobrevivientes de MVC un año después del trauma. Confirmamos que las respuestas peritraumáticas son útiles para predecir la gravedad de los síntomas del TEPT. Estos resultados podrían incentivar la implementación de programas de seguimiento no solo para las sobrevivientes sino también para sus madres.

Prevalence of positive toxicology analysis from the French national registry for sudden unexpected infant death (Tox-MIN).

BACKGROUND: Sudden unexpected infant death (SUID) remains the leading cause of postnatal mortality in many countries. French and international guidelines recommend a thorough examination with toxicology studies. OBJECTIVES: The main objective was to determine the prevalence of toxic detection and positive analyses. The secondary objectives were to describe the different toxics and compare children with positive (Tox+) and negative results (Tox-) with other SUID risk factors. DESIGN AND METHODS: We used the data registered from May 2015 to December 2018 by the French national SUID registry (OMIN). It collects data for all SUID cases admitted to any of the 35 participating French SUID referral centers. RESULTS: Of the 624 SUID cases registered in the OMIN, a post-mortem toxicological analysis was performed in 398 infants. Thirty-six patients (9%) were positives for expected (Etox+ (n = 19 [53%], e.g., resuscitation drugs, regular treatments) and unexpected (UTox+) (n = 17 [47%]) toxics. The unexpected toxics were opioids (n = 8), cannabis (n = 4), cocaine (n = 3), cotinine (n = 2), carbon monoxide (n = 2), caffeine (n = 2), alcohol (n = 1) and GHB (n = 1). UTox + infants had a different seasonal distribution (p = .03), a higher incidence of inappropriate sleeping position and bedding at the time of death (respectively OR 3.8, p = .037 - OR 5.4, p = .026); inadequate body hygiene (OR 10.6, p = .0005), a younger maternal age (p = .045) and a higher rate of maternal drug abuse (OR 21.9, p = .0008). CONCLUSION: The high rate of positive results warrants routine toxicology testing. The imputability of identified molecules is complicated by the presence of other known risk factors for SUID.

Impact of the French National Lockdown on Admissions to 14 Pediatric Intensive Care Units During the 2020 COVID-19 Pandemic-A Retrospective Multicenter Study.

Background: After the COVID-19 pandemic reached France in January 2020, a national lockdown including school closures was officially imposed from March 17, 2020, to May 10, 2020. Pediatric intensive care units (PICUs) admit critically ill infants, children and teenagers with severe acute conditions, in particular infectious and traumatic diseases. We hypothesized that PICU admissions would be considerably modified by the lockdown. Aims: The objectives of the study were to describe the type of admissions to French PICUs and to compare the occupation of PICU beds according to local epidemic conditions during the French national lockdown period, compared with the same period the previous year. Methods: We conducted a retrospective multicenter study in 14 French PICUs. All children aged from 7 days to 18 years admitted to one of the 14 participating PICUs over two 3-month period (March 1, 2020, to May 31, 2020 and March 1, 2019, to May 31, 2019) were included. Analysis was based on data extracted from the medicalized information systems program (a national database used in all French hospitals, into which all admissions and their diagnoses are coded for the purpose of calculating hospital funding). Each main diagnosis was reclassified in 13 categories, corresponding to normal PICU admissions. Results: We analyzed a total of 3,040 admissions, 1,323 during the 2020 study period and 1,717 during the same period in 2019. Total admissions decreased by 23% [incidence rate ratio (IRR) 0.77, 95% CI 0.71-0.83, p < 0.001], in particular for viral respiratory infections (-36%, IRR 0.64, 95% CI 0.44-0.94, p = 0.001). Admissions for almost all other diagnostic categories decreased, except intoxications and diabetes which increased, while admissions for cardiac and hemodynamic disorders were stable. Patient age and the sex ratio did not differ between the two periods. Median length of stay in the PICU was longer in 2020 [4 (IQR 2-9) vs. 3 (IQR 1-8) days, p = 0.002] in 2019. Mortality remained stable. Conclusions: In this large national study, we showed a decrease in the number of PICU admissions. The most severe patients were still admitted to intensive care and overall mortality remained stable.

Clinical course and cost assessment of infants with a first episode of acute bronchiolitis presenting to the emergency department: Data from the GUERANDE clinical trial.

INTRODUCTION: Bronchiolitis is the leading cause of hospitalization for infants but its economic burden is not well documented. Our objective was to describe the clinical evolution and to assess the 1-month cost of a first episode of acute bronchiolitis presenting to the emergency department (ED). METHODS: Our study was an epidemiologic analysis and a cost study of the cohort drawn from the clinical trial GUERANDE, conducted in 24 French pediatric EDs. Infants of 6 weeks to 12 months of age presenting at pediatric EDs with a first episode of bronchiolitis were eligible. The costs considered were collected from a societal viewpoint, according to the recommendations of the French National Health Authority. RESULTS: A total of 777 infants were included with a median age of 4 months. A total of 57% were hospitalized during the month following the first consultation in the ED, including 28 (3.6%) in an intensive care unit. The mean length of stay was 4.2 days (SD = 3.7). The average time to relief of all symptoms was 13 days (SD = 7). Average total cost per patient was €1919 (95% confidence interval: 1756-2138) from a societal perspective, mostly due to hospitalization cost. The estimated annual cost of bronchiolitis in infants was evaluated to be between €160 and €273 million in France. DISCUSSION: Bronchiolitis represent a high cost for the health care system and broadly for society, with hospitalizations costs being the main cost driver. Thus significant investments should be made to develop innovative therapies, to reduce the number of hospitalizations and length of stay.

Symptoms of traumatic stress in mothers of children victims of a motor vehicle accident.

BACKGROUND: Motor vehicle accidents (MVAs) are the main cause of Posttraumatic stress disorder (PTSD) in industrialized countries. This includes the frequently occurring but understudied situation of parents learning that their children were injured. However, unlike in other types of trauma survivors, little is known about the predictors of PTSD symptoms in mothers whose child has suffered an MVA. METHODS: A group of 72 mothers and 28 fathers were prospectively assessed for peritraumatic distress, peritraumatic dissociation, and PTSD symptoms 1 and 5 weeks after their child had suffered an MVA. RESULTS: Levels of peritraumatic distress and dissociation were comparable to other trauma victims, 18% of the mothers were considered to be suffering from probable PTSD. In mothers, significant positive correlations were found between PTSD symptoms and peritraumatic distress (r=.34) and dissociation (r=.37), whereas mothers' PTSD symptoms were associated with decreased peritraumatic dissociation in fathers (r=-.37). Even after controlling for covictim/witness status, peritraumatic distress was a predictor of mothers' PTSD symptoms, explaining 14% of the variance. CONCLUSIONS: Peritraumatic response and PTSD symptoms should be routinely assessed among parents whose child has experienced a traumatic event.