[Food intake during the previous 24h as a percentage of usual intake: a marker of hypoxia in infants with bronchiolitis: an observational, prospective, multicenter study]. / Bronchiolite et prise alimentaire des dernières 24h: un outil de dépistage de l'hypoxie.

BACKGROUND: Hypoxia associated with bronchiolitis is not always easy to assess on clinical grounds alone. The aim of this study was to determine the value of food intake during the previous 24h (bottle and spoon feeding), as a percentage of usual intake (24h FI), as a marker of hypoxia, and to compare its diagnostic value with that of usual clinical signs. METHODS: In this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants, aged from 0 to 6 months, with bronchiolitis (rhinorrhea+dyspnea+cough+expiratory sounds). Infants with risk factors (history of prematurity, chronic heart or lung disorders), breast-fed infants, and infants having previously been treated for bronchial disorders were excluded. The 24h FI, subcostal, intercostal, supracostal retractions, nasal flaring, respiratory rate, pauses, cyanosis, rectal temperature and respiratory syncytial virus test results were noted. The highest stable value of transcutaneous oxygen saturation (SpO2) was recorded. Hypoxia was noted if SpO2 was below 95% and verified. RESULTS: 24h FI greater or equal to 50% was associated with a 96% likelihood of SpO2 greater or equal to 95% [95% CI, 91-99%]. In univariate analysis, 24h FI less than 50% had the highest odds ratio (13.8) for SpO2 less than 95%, compared to other 24h FI values and other clinical signs, as well as providing one of the best compromises between specificity (90%) and sensitivity (60%) for identifying infants with hypoxia. In multivariate analysis with adjustment for age, SpO2 less than 95% was related to the presence of intercostal retractions (OR=9.1 [95% CI, 2.4-33.8%]) and 24h FI less than 50% (OR=10.9 [95% CI, 3.0-39.1%]). Hospitalization (17 infants) was strongly related to younger age, 24h FI and intercostal retractions. CONCLUSION: In practice, the measure of 24h FI may be useful in identifying hypoxia and deserves further study.

[Impact of influenza rapid diagnostic tests (IRDT) on the diagnosis of influenza and on the management of influenza in children in ambulatory pediatric setting]. / Impact des tests de diagnostic rapide de la grippe dans la prise en charge des enfants en période d'épidémie en pédiatrie de ville.

OBJECTIVE: Several studies have highlighted the assets of the influenza rapid diagnostic tests (IRDT) for the emergency department management of febrile children. The objective of this study was to determine in ambulatory pediatric setting impact of IRDT on the management of febrile children during an epidemic, especially on other diagnostic testing performed, antibiotic and antiviral treatments. METHODS: During an influenza epidemic, 37 paediatricians in three different areas of France included all children presenting fever with respiratory illnesses; they performed IRDT (test QuickVue for Influenza A and B, Quidel). Data collected were antiflu vaccination, previous asthma, symptoms, clinical signs, other diagnostic testing performed, and a follow-up two weeks later. RESULTS: Between December, 2006 and April, 2007, 695 children entered the program. The average age of those children was 4.1 years old (SD 3.4), median 3.2 (0.07-17.5). In 41.6% of the cases, the tests proved positive. Among 13 symptoms of influenza, only five were significantly more present in the group IRDT+: shiver (68.1% versus 57.4%), asthenia (87% versus 79.9%), cough (87.5% versus 70.1%), rhinorrhea (93.4% versus 83.3%), and sleepiness (54.2% versus 43.4%). The number of laboratory tests and radiographs ordered were less frequent in group IRDT+ than in group IRDT-: respectively 0.7% versus 11.6%, and 0.7% versus 8.6% (p<0.0001). IRDT+ group received antibiotics in 7.6% of cases (22 patients, 20 for OMA) and antiviral in 64.7%. IRDT- group received respectively 18.5% antibiotics, and no antiviral (p<0.0001). CONCLUSION: This study confirms the difficulty of clinical influenza diagnosis, and suggests the assets of IRDT to diagnose influenza and to improve the management of influenza in ambulatory paediatric setting.

[Evaluation of impact of CRP rapid test in management of febrile children in ambulatory pediatric practice]. / Evaluation de l'impact du test rapide de la CRP en microméthode par des pédiatres de ville prenant en charge des enfants de plus de trois mois avec fièvre isolée.

OBJECTIVE: Fever without source (FWS) is a common cause of children visits to pediatric practices. Clinical evaluation does not always rule out efficiently an invasive bacterial infection. Among blood markers, several publications have suggested the value of C-reactive protein (CRP). This study was performed to assess, in private practices, the impact of rapid CRP test compared to usual technique at the laboratory for the management of children with FWO. MATERIAL AND METHODS: The study was undertaken in 2006-2007, in 14 pediatric practices. Pediatricians had to enroll all children, older than three months, consulting for FWS, for whom CRP was prescribed. The pediatric practices were distributed in two groups: in the first one, pediatricians had rapid CRP tests (NycoCard) CRP test, Progen Biotechnique) and in the second one, they sent children to laboratory for the dosage of CRP as usually. RESULTS: Between October 2006 and June 2007, 227 children were enrolled by 17 pediatricians: 159 in the group with rapid CRP test (group 1), 68 in the group without (group 2). The cost of routine biological tests (micro or macro CRP, blood cell count and urine cultures) was on average lower for group 1 compared to the group 2: respectively 7.7 versus 39.3 euro (P<0.0001), a reduction from approximately 80% of cost. In group 1, more dipstick urine tests (22.6 versus 4.4, P=0.0009), less urine cultures (19.5% versus 67.6% P<0.0001) and blood prescriptions were prescribed (3.8% versus 100%, P<0.0001), pulmonary X-rays were not different (23.9% versus 19.1%, P=0.4). It was not observed difference in antibiotic prescription between the two groups (15.7% group 1 versus 19.1% group 2, p=0.5). The average time to obtain the results examinations in laboratory was approximately 11h (median 4.5h, extremes 45 min to two days), for five min in group 1. In group 1, children management was different according to the CRP levels. During the follow-up, no difference was observed between the two groups except less hospitalizations in group 1 (2.9% versus 15.3%, P=0.0015). CONCLUSION: This study suggests the interest of rapid CRP test for febrile children in ambulatory pediatric practice by reducing number and cost of laboratory examinations and timesaving for patients and practitioners.

[Vaccination in parents of young infants survey]. / Enquête sur le statut vaccinal des parents de jeunes nourrissons.

Since 2004, in France, pertussis booster is recommended in parents of young infants and adults likely to become parents. This recommendation adds to others such as rubella vaccination in unvaccinated or seronegative women and decennial dT-IPV booster. The objective of this study is to evaluate the impact of these recommendations in parents of young infants. Pediatricians had to include parents of infants at the first well-baby visit after birth. Vaccination data were secondary recorded from parent's health record or called upon their memory. Between June and October 2006, 41 pediatricians included parents of 400 infants (median age: 36 days). dT-IPV booster was recorded or recalled in 37.4% within the 10 previous years and 17.7% within the 3 previous years. Among this last group, only 11.8% had received a combination including pertussis. Rubella serology was declared as positive by 94% of the mothers, but the physicians obtained the information of a previous rubella vaccination in only 71.7% of the mothers. Among the 9 seronegative mothers during pregnancy, only 3 were vaccinated in postpartum. Adults' immunization guidelines are not well known and poorly applied in France. The unavailability of monovalent pertussis vaccine reduces the eligible population. Two years after the launch of the pertussis cocoon strategy, the coverage of eligible young parents remains low and many opportunities are too frequently missed on the opportunity of decenial dTPolio booster. Rubella catch up strategy should be improved. Adults' vaccination strategies and guidelines need to be better broadcasted to health care professionals and also families.

Verification of the Schaltenbrand and Wahren stereotactic atlas.

The Schaltenbrand and Wahren stereotactic atlas was critically re-examined focusing on the technical quality and the consistency of the horizontal, sagittal and frontal microscopic cut series. From each series, both an isotropic contour and a solid volume model represented by a 256 matrix with an edge length of 6.4 cm were created using 3D-interpolation. Reslicing of the solid volumes in corresponding orthogonal planes enabled thorough direct comparison of the three series. In a 3D-navigation system prototype, the contour models can be matched to MRI and CT series. Different procedures for rigid matching including landmark matching were implemented. As regards the verification criteria, the frontal Schaltenbrand and Wahren series yielded the most comprehensible results whereas in the horizontal and sagittal series artifacts appear more pronounced.