[Ketoacidosis at time of diagnosis of type 1 diabetes in children and adolescents: effect of a national prevention campaign]. / Effet à un an de la campagne nationale de prévention de l'acidocétose au moment du diagnostic de diabète de type 1 chez l'enfant et l'adolescent.

The aim of the study was to evaluate, after the first year of a national information campaign, the effect on the frequency and severity of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) in children and adolescents in France. The following data were collected during a 2-year period in people younger than 15 years of age at diagnosis of T1D, in 146 pediatric centers: age, sex, duration of symptoms, patient's previous care, clinical and biological signs, and family history of T1D. DKA was defined as pH<7.30 or bicarbonate<15mmol/L, severe DKA as pH<7.10 or bicarbonate <5mmol/L. During the 2nd year, an information campaign targeting health professionals and families was launched with the objective of reducing the time to diagnosis. Data were compared between the year before the campaign (year 0) and the first year of the campaign (year 1). The number of new cases of T1D was 1299 for year 0 and 1247 for year 1. Between year 0 and year 1, the rate of DKA decreased from 43.9% to 40.5% (P=0.08), exclusively due to the decrease of severe DKA from 14.8 to 11.4% (P=0.01). In the 0- to 5-year-old and 5- to 10-year-old age groups, the relative decrease in the rate of DKA was 13% and 15%, and 23% and 41% for severe DKA, respectively. In patients referred to the hospital by a pediatrician or who came at the family's initiative, the decrease was 34% and 7%, and 39% and 32% for severe DKA, respectively. No change was observed in the 10- to 15-year-old group or in those children who were referred by a general practitioner. In multivariate analyses, a higher DKA rate was associated with the young age of the child (<5 years), being hospitalized at the parents' initiative rather than being referred by a doctor, and the absence of a family history of T1D. A higher rate of severe DKA was associated with these last two factors but not with the child's age. The frequency of DKA at diagnosis of type 1 diabetes remains high in children and adolescents, but the first year of an information campaign decreased it. The results have also helped better define the strategy and targets of the continuing prevention campaign, to more efficiently reduce the morbidity and mortality of T1D at diagnosis in children and adolescents in France.

[Milk feeding of infants and cow's milk protein hypersensitivity]. / Alimentation lactée du nourrisson et allergie aux protéines du lait de vache.

BACKGROUND: Cow milk protein intolerance (CMPI) is characterized by a wide range of symptoms and signs affecting the gastro-intestinal tract, the respiratory system and the skin. A better definition, a stricter application of diagnostic criteria and critical evaluation of certain immunologic correlates can contribute to a better understanding and preventive treatment of this entity. POPULATION AND METHODS: Two hundred-seventeen infants with CMPI seen between January 1980 and December 1993 were included in the study. They were classified into two groups: 1) acute reaginic CMPI (type I): 125 infants and 2) CMP enteropathy or colitis (type III or IV): 92 infants, according to classical diagnostic criteria. Careful investigation concerning the type of milk feeding (breast or artificial) proposed prior to clinical manifestations was performed. RESULTS: Among the 125 infants (aged 3 to 20 weeks) with acute reaginic CMPI, 121 (97%) had been breast-fed with a sudden weaning; 30 of these infants had also received one to three formula bottles during the first 3 days of life and 14 certainly had not received such formula bottles. Among the 92 infants with CMPI, type III or IV, 33 (38%) had been exclusively breast-fed, a figure quite similar to the breast feeding incidence in our region. CONCLUSIONS: These results clearly show the importance of breast-feeding in the personal history of CMPI. Acute reaginic type of CMPI is favored by early ingestion of formula bottles in breast-fed infants and by early sudden weaning. Hypoallergenic formula in five cases was unable to protect infants against further allergic manifestation.

[Acute hepatopathy compatible with Reye's syndrome in 3 children treated by chemotherapy]. / Hépatopathie aiguë compatible avec un syndrome de Reye chez trois enfants traités par chimiothérapie.

BACKGROUND: Chemotherapy for malignant diseases sometimes leads to hepatic toxicity. Reye's syndrome has not been described in such a situation. CASE REPORTS: Three children, 4, 5 and 6 years-old, were treated for lymphoma or acute lymphoblastic leukemia. They were given polychemotherapy including drugs that were not potentially hepatotoxic. During remission, they suddenly developed manifestations such as neurologic disturbances, hepatomegaly, increased activity of liver enzymes, and microvesicular steatosis. These disturbances were consistent with the diagnostic criteria for Reye's syndrome recommended by the Centers for Disease Control. Factors such as viral infection, salicylate administration, primary metabolic disorder were not present. One child died and the other two recovered completely. CONCLUSION: Patients given chemotherapy, even though the relationship between them remains to be determined, may develop manifestations compatible with a diagnosis of Reye's syndrome.

[Educational strategies for diabetic children and adolescents]. / Stratégies éducatives en diabétologie pédiatrique.

Therapeutic education in pediatric diabetology aims to reconcile the medical requirements related to the disease, its risks, and its treatment, and to promote children's acquisition of skills to assist them in living with the disease. This can only be accomplished by individualized support based on team work. The approach is systemic with educational assessment, core skills guide, objectives, learning sessions, and evaluation. The skills are defined by domain and in relation to children's capacities according to age, based on Piaget's developmental stages. Therapeutic education is part of the children's treatment plan and requires taking into account their dependence on the adults they live with as well as their interpersonal surroundings. These educational programs are addressed not only at the child, both individually and collectively, but also to parents who are learning to develop patient-parent and parent-care-giver skills without losing sight of the child as the beneficiary. It seems important to work on transferring the parents' skills to the child. Therapeutic education is proposed throughout the child's care, from announcement of the diagnosis to the transition to adult diabetology departments. Programs designed to accompany siblings, grandparents, teachers, or other resource people cannot be ignored so that children with diabetes are cared for in their entirety and they can achieve their full potential.

[Digestive and nutritional manifestations of Netherton's syndrome]. / Manifestations digestives et nutritionnelles du syndrome de Netherton.

Netherton's syndrome is a group of skin diseases where the cutaneous lesions may be associated with chronic digestive symptoms. We have observed five cases over a 10 year period, of which three in the same family. Management of nutritional and digestive problems was of major importance for vital prognosis. The literature data concerning the digestive involvement in Netherton's syndrome and the different associations between skin diseases and gastro-intestinal signs have been reviewed. The presence of villous atrophy in three of the five children suggests that a jejunal biopsy should be carried out in each case of Netherton's syndrome. Nutritional artificial support appears primordial at the initial stage of the illness, in order to maintain normal growth. Allergenic protein-free diet should not be systematic but discussed for each case and depend on the allergic and digestive laboratory results.