[Gastroesophageal reflux and sleep position of infants. A survey conducted in France by 493 pediatricians]. / Reflux gastro-œsophagien et position de couchage des nourrissons. Enquête de pratique menée en France auprès de 493 pédiatres.

BACKGROUND AND AIMS: The supine sleeping position with the head higher than the legs has no impact on regurgitations in infants. Inclined ventral decubitus decreases regurgitations but is associated with an increased risk of sudden infant death syndrome (SIDS). The LUNE study aimed to evaluate the impact of regurgitations on the choice of sleeping position by pediatricians and parents. METHODS: Cross-sectional case-control study (ratio 1:1) conducted in France in 2013. A representative sample of pediatricians recruited 3-week to 4-month-old breast- or formula-fed infants. Cases and controls were defined by the presence or absence of regurgitations. Collected data included Vandenplas codification for regurgitations (VD, range 0-6), associated symptoms, and variations in sleeping position since maternity hospital discharge. RESULTS: A total of 1347 cases and 1346 controls were recruited by 493 pediatricians. Regurgitations were evaluated at VD1 (minor, 22 % of cases), VD2 (mild, 47 % of cases), or VD≥3 (moderate to severe, 31 % of cases). At the maternity hospital, the supine position was recommended to 96 % of parents for SIDS prevention. Since discharge, parents asked questions about the relationship between sleeping position and regurgitations (79 % of infants with GER versus 45 % of controls). The sleeping position was modified at least once since maternity discharge (42 % of infants with GER versus 35 % of controls). At inclusion, 86 % of infants with GER and 86 % of controls were sleeping on their back. Fifty-one percent of infants with GER and 28 % of controls slept in an inclined position. Pediatricians repeated the prescription of dorsal decubitus for 91 % of infants with GER and recommended an inclined position in 70 %. CONCLUSIONS: Regurgitations had no impact on supine sleeping position. The inclined supine sleeping position was more frequent in infants with regurgitations with pediatricians' assent, which is not in agreement with evidence-based medicine.

[So much to do for the children of Africa]. / Tant a faire pour les enfants d'Afrique]

PIP: Despite progress in child health in countries of North Africa, the status of child health in all other parts of Africa is grave. High rates of fertility averaging 50/1000 (compared to 12/1000 in Europe), infant mortality rates of 125/1000 except in Morocco, Tunisia, and a few large sub-Saharan cities, and life expectancies of 40-50 years are indicative of serious problems in providing health services. Public health expenditures in Africa average US $2 per capita, compared to $244 in developed countries. Rates of literacy, an indispensable tool in the fight for health, range from 15% for man and 3% for women in Burkina Faso to 74% for men and 37% for women in Zaire. Epidemiologic data are lacking and surveys are costly, but some problems such as the great frequency of nutritional deficiency diseases and contagious illness resulting from poor hygiene are obvious. Infections contracted by children aged 1-5 years are often avoidable. Urbanization and changing life styles cause new problems such as domestic or traffic accidents and pathologies of adolescents. Health personnel and infrastructure are insufficient in all African countries. The ratio of physicians to population ranges from 1/10-20,000, at least double the ratio of 1/5000 recommended by the World Health Organization. Hospitals and health centers are poorly distributed, and rural areas often totally lack facilities. Seminars on child health services were held in 13 African countries for officials of all involved sectors prior to a July 1987 meeting in Montreal on the occasion of the Annual Congress of the Society of French speaking pediatricians. 2 essential points emerged from the profiles presented by each national delegation, the need for programs adapted to local problems that would give results quickly, and the need to train health workers and provide health education to the population. Priority should be given to prevention through good hygienic conditions, proper nutrition, and environmental sanitation, as well as individual and family health. Strategies for health action must be developed, with a focus on prevention and family planning, adaptation of traditional medicine, and better training of health manpower. Health programs should be integrated into primary health care programs, which to have maximal impact, should be integrated into broader socioeconomic development programs. Regional strategies can be elaborated by countries with similar problems.^ieng

Effect of diosmectite on intestinal permeability changes in acute diarrhea: a double-blind placebo-controlled trial.

The effect of diosmectite on intestinal permeability changes in acute diarrhea was measured during a double-blind placebo-controlled trial carried out in 59 Gabonese children aged 5-35 months. Intestinal permeability tests (IPTs), measuring the urinary elimination of orally administered lactulose and mannitol at a dosage of 1 g/10 kg each, were performed during the morning following admission and repeated 2 days later after treatment by diosmectite or placebo. During the first IPT, urine volume and lactulose and mannitol urinary recoveries were comparable in the diosmectite and in the placebo groups: 50 vs. 35.5 ml (median; p = 0.21), 1.01 vs. 1.27% (p = 0.35), and 2.20 vs. 2.87% (p = 0.12). As a result, the lactulose/mannitol (L/M) ratio was similar in the two groups: 44.44 vs. 35.33% (p = 0.98). During the second IPT, the urinary lactulose recovery decreased similarly in both groups (-0.18 vs. -0.29%; p = 0.76), whereas the urinary mannitol recovery exhibited opposite variations, the increase in the diosmectite group (+ 1.43%) contrasting significantly with the decrease in the placebo group (-0.47%; p = 0.01). When comparing the first and the second IPT, the decrease of the L/M ratio was significant in the diosmectite group (44.44 vs. 28.32%; p = 0.02) and not in the placebo group (35.33 vs. 48.23%; p = 0.91). During gastroenteritis, diosmectite appears to enhance absorption of mannitol, a marker of intestinal absorptive area.

Distinct features of upper gastrointestinal endoscopy in the newborn.

Between January 1987 and December 1990, 293 upper GI endoscopic procedures were performed in 219 neonates < 1 month of age. No lesion was found in 57 cases (26%; group 1), whereas esophagitis was present in 158 cases, alone in 45 cases (20.6%; group 2) and associated with gastritis in 113 cases (51.8%; group 3). The association of esophagitis with gastritis seems to be a specific feature of neonates and not older children. The presence of gastritis with esophagitis suggests that a primary peptic mechanism is unlikely to explain all endoscopic findings, although the presence of such a mechanism secondary to esophagitis could contribute to the esophageal lesions. Acute fetal distress was more frequent in group 3 than in the other groups. Symptoms associated with endoscopic lesions in groups 2 and 3 were, respectively, malaise (38 and 42%), hematemesis (4 and 35%), frequent regurgitation (45 and 26%), and difficult feeding and/or failure to thrive (26 and 24%). In Group 3, minor symptoms often led to the diagnosis of severe mucosal lesions, and antireflux therapy elicited prompt relief of clinical symptoms. The causes of neonatal esophagogastritis remain unknown. Wide use of endoscopy in the presence of discrete clinical abnormalities is likely to considerably improve the clinical condition of some children in their first days of life.

[Esophagogastroduodenitis in the newborn. Apropos of 32 cases]. / Les oesophagogastroduodénites du nouveau-né. A propos de 32 cas.

Inflammatory lesions involving esophagus, stomach and duodenum are frequent in neonates and run a benign course. Thirty-two cases of esophagogastritis associated with duodenitis in 28% of cases were studied. Presenting symptoms included nonspecific symptoms such as feeding difficulties (15 cases), G-I bleeding (14 cases), regurgitation (14 cases) and/or impaired weight gain (4 cases). No precipitating factor could be identified. The diagnosis was established by endoscopy. Gastro-esophageal reflux, which seemed to be secondary to the mucosal lesions, required an anti-reflux treatment, which led to a rapid clinical recovery. Repeat endoscopy invariably showed an improvement or complete recovery of the mucosal lesions which did not seem to be influenced by antacid treatment. The etiology and pathogenesis of neonatal esophagogastroduodenitis remain undetermined.