Strengths and limitations of a policy for handling and following up suspected pediatric cases of SARS-CoV-2 infection.

To compensate for the poor initial knowledge about pediatric SARS-CoV-2 infections and the limited access to non-urgent medical care during lockdown, a local telephone follow-up program was set up to remotely monitor children with confirmed or suspected SARS-CoV-2 infection at the pediatric emergency department of a French tertiary hospital. We retrospectively assessed 131 children. A total of 488 phone call attempts resulted in 293 (60%) teleconsultations. This telephone follow-up program was simple and appeared necessary in the first stage of the pandemic with an emergent pathogen. However, it was time-consuming and should be improved for further use.

[Value of procalcitonin for infants with bronchiolitis in an emergency department]. / Dosage de la procalcitonine et bronchiolites vues dans un service d'accueil des urgences pédiatriques.

CONTEXT: Very few studies have evaluated the role of procalcitonin (PCT) in infants with bronchiolitis. AIMS: To describe infants who had both a diagnosis of bronchiolitis at the emergency department and a blood test including PCT, and to compare the characteristics of children according to the PCT value. METHODS: Infants admitted to the Pediatric Emergency Department between 1 January 2014 and 31 December 2014 who had a diagnosis of bronchiolitis and a blood test including PCT were included. The clinical, biological, and radiological characteristics of the infants with PCT <1 or ≥1g/L were compared. RESULTS: One hundred thirty six infants were included. Patients with high PCT (n=20) had a higher temperature (38.5°C, IQR=37.8-38.6 vs. 37.5°C, IQR=37.1-38.2; P<0.01), C-reactive protein (50mg/L, IQR=25-83 vs. 5mg/L, IQR=0-19; P<0.01), and neutrophils (7.8×109/L, IQR=6.0-8.5 vs 4.5×109/L, IQR=2.9-6.6; P<0.01) higher than patients with low PCT (n=116). Presence on the chest x-ray of alveolar condensation did not differ between the two PCT groups. Infants coming from the low-PCT group received fewer antibiotics (14.7% vs 65%; P<0.01). CONCLUSION: In a Pediatric Emergency Department, PCT with a value of 1 or more cannot predict the presence of alveolar condensation on the chest x-ray. It seems to be associated with the antibiotics prescription, even if this could not be proved because of the design of the study.

[Septic arthritis in children with normal initial C-reactive protein: clinical and biological features]. / Arthrite septique de l'enfant à protéine C-réactive initialement normale : description clinique et biologique.

Septic arthritis has to be suspected in children with joint effusion and fever so as to perform joint aspiration, which will confirm the diagnosis by bacteriological methods, and to perform surgical treatment by joint lavage. Since development of current molecular methods, such as real-time PCR, Kingella kingae has become the first microbial agent of osteoarticular infections in young children, whereas Staphylococcus aureus is second. C-reactive protein (CRP) is an aid used to diagnose septic arthritis, but its elevation could be moderate. In a previous study, conducted at our hospital, 10% of children hospitalized for S. aureus or K. kingae septic arthritis had a CRP level<10 mg/L. To determine if diagnosis of septic arthritis could be made by other parameters, we analyzed the clinical and biologic features of these patients and compared them to those of children hospitalized for septic arthritis with initial CRP ≥10 mg/L. Among the 89 children with septic arthritis, 10% (n=9) had initial CRP<10 mg/L (K. kingae, n=5/63 ; S. aureus, n=4/26). Initial temperature and fibrinogen were significantly lower in the CRP<10 mg/L group than in the other (37.3°C vs. 37.9°C, P=0.039 and 4.19 vs. 5.72 g/L, P=0.003, respectively). Age, symptom duration before diagnosis, as well as leukocyte and platelet counts were similar in both groups. Two children (2/89=2.2%) with S. aureus septic arthritis had no fever, CRP elevation, or fibrinogen elevation. In the CRP-negative group, three of four children with S. aureus arthritis and one of five with K. kingae arthritis had a high CRP level (34, 40, 61, and 13 mg/L, respectively) 3 days after surgery and antibiotic treatment. One child with K. kingae septic arthritis and initial CRP<10 mg/L needed a second surgical drainage because of relapse of arthritis. In the S. aureus arthritis group, none of the children with initial CRP<10 mg/L experienced complications, while six of those with initial CRP≥10 mg/L needed a second surgical act or hospitalization in an intensive care unit. While CRP is most often>10 mg/L during septic arthritis in children, it could be negative in up to 20% of patients in different studies. However, a mild inflammatory syndrome or even a CRP<10 mg/L cannot exclude diagnosis of septic arthritis. Therefore, a first episode of monoarthritis in children has to be considered as septic arthritis and treatment should not be delayed.