[A survey on attention deficit hyperactivity disorder]. / Enquête sur le trouble déficit de l'attention avec hyperactivité auprès de pédiatres libéraux.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder described in international classifications and thought to affect about 5% of school-aged children and 3% of adults in the general population. In France, most clinicians are not formally trained in assessing and treating ADHD, leading to underdiagnosis of the disorder. ADHD impacts all the aspects of these children's daily life (school performance, family and social life) and later their adult life. We invited all the private-practice pediatricians in the east of the Provence-Alpes-Côte d'Azur region (southeast France) to participate in a survey: 57 out of 81 accepted. The results show that their knowledge on ADHD could be improved, and that their a priori conception of the etiology of the disorder (neurodevelopmental syndrome versus societal syndrome) guides their clinical approach. We recommend pediatricians be trained to improve screening, diagnosis, and ADHD treatment monitoring in children. This recommendation might also apply to general practitioners for children and parents/adults.

[Streptococcus pneumoniae-induced hemolytic uremic syndrome: a serotype-3-associated case]. / Syndrome hémolytique et urémique secondaire àStreptococcus pneumoniae de sérotype 3.

Hemolytic uremic syndrome (HUS) is the primary cause of acute renal failure in children younger than 3 years of age. It usually occurs after a diarrheal illness due to Shiga-toxin-producing Escherichia coli. Streptococcus pneumoniae (SP)-induced HUS remains rare, involving 5% of all cases of HUS in children, but its frequency has increased over the last decade. The incidence of HUS following invasive pneumococcal infections is estimated at 0.4 to 0.6%. We report here the case of a 3.5-year-old child who presented SP serotype-3-associated HUS. The diagnosis was suspected by the patient's multiple organ failure. The pathogenesis involves the activation of the Thomsen-Friedenreich antigen. To prevent transfusion-associated hemolysis, it is recommended that fresh-frozen plasma or unwashed blood products should be avoided when possible. Our patient was transfused with 4 units of unwashed red blood cell and 2 units of fresh-frozen plasma. No special complication was noted. The risk of immediate complications requires close clinical and biological monitoring, and the possibility of starting dialysis immediately. Twenty-five to 35% of SP-HUS patients exhibit long-term renal aftereffects. The acute mortality rate depends on the site of infection. The increased frequency of SP-HUS may be related to the new ecology of serotypes created by widespread Prevenar7(®) vaccination.

[Abdominal aortic injury in a child: seat-belt syndrome]. / Traumatisme de l'aorte abdominale : « le syndrome de la ceinture de sécurité ¼

Traumatic injuries of the abdominal aorta are rare, especially in the pediatric population, but they must be sought when the clinical signs are associated with a severe traumatic context. We report the case of a 7-year-old child who presented with a partial transection of the abdominal aorta following a traffic accident. The optimal management is based on the detection of the less striking but suggestive clinical signs, such as a belt hematoma in the abdominal wall or a decreased pulse in the lower limbs, as well as a systematic precise X-ray examination, and an urgent surgical intervention. The risk is complete rupture, whose time of occurrence after the accident is unpredictable. The abdominal aorta is anatomically protected, so injury in children is traditionally associated with seat belt wear. Lesions are related to the shearing of the abdominal aorta between the spine and the seat belt.