Co-Development of Three Dietary Indices to Facilitate Dietary Intake Assessment of Pediatric Crohn's Disease Patients.

Literature on dietary behaviours of the pediatric Crohn's Disease (CD) population and the relationship between dietary intake and CD activity is limited. Three dietary indices were developed and tested to conduct dietary pattern analysis in pediatric patients with CD consuming a free diet following remission induction via exclusive enteral nutrition (n = 11). Index scores underwent descriptive and inferential analysis. The mean adjusted scores (out of 100) for the Pediatric Western Diet Index, Pediatric Prudent Diet Index, and Pediatric-Adapted 2010 Alternate Healthy Eating Index (PA2010-AHEI) were 29.82 ± 15.22, 34.25 ± 15.18, and 51.50 ± 11.69, respectively. The mean Western-to-Prudent ratio was 0.94 ± 0.55. A significant correlation (r = -0.71) and relationship (F[1, 9] = 9.04, P < 0.05, R2 = 0.501) between the Western-to-Prudent ratio and PA2010-AHEI was found. The results suggest participants were not following a Western or Prudent diet, and were consuming foods not captured by the indices. More research is needed to describe dietary intake of individuals with CD, validate dietary indices in diverse samples, and explore the utility of these indices in CD assessment and treatment. The co-authors hope this work will stimulate/inspire subsequent interprofessional, dietitian-led research on this topic.

[Overview of hospital city repay for paediatric preparations initiated within the Marseille Public University Hospital system]. / État des lieux des modalités de poursuite en ville des préparations pharmaceutiques à usage pédiatrique initiées au sein de l'Assistance publique des Hôpitaux de Marseille.

OBJECTIVES: Hospital internal-use pharmacies are required to make pharmaceutical preparations in order to obtain a medication in a dosage and/or Galenic form (FG) suitable for pediatric use. The aim of this study is to assess the procedures for continuing pharmaceutical preparations initiated within the Assistance Publique des Hôpitaux de Marseille in an outpatient setting. METHODS: Hospital discharge prescriptions and/or consultation prescriptions involving paediatric magistral preparations and issued by our Hospital Centre were collected from two pharmacies with significant preparation activity at national level. An analysis of regulatory compliance was carried out, as well as a comparison of the formulation of preparations made in the outpatient setting and in the hospital. RESULTS: Au total, 45 prescriptions were collected, representing 52 preparation lines. The regulatory analysis revealed that all the prescriptions contained at least one non-conformity, 60.8% of which related to drug treatments. The prepared FG differed in the outpatient setting compared to the hospital in 46.2% of cases, and in 56% of cases, the vehicle and concentration of the active ingredient used differed when the FG was a liquid oral form. CONCLUSIONS: The lack of clear and complete hospital prescriptions makes it difficult to carry out treatment initiated in hospital in the outpatient setting. The multiplicity of information systems between hospitals and outpatient settings are obstacles to the interoperability needed to coordinate patient treatment, particularly in paediatrics. The quality of discharge prescriptions needs to be improved to optimise the patient care pathway.

[Consensus update of the POPI tool]. / Mise à jour par consensus de l'outil POPI.

Medication errors are one of the causes of iatrogenic medication use in children. The POPI tool for detecting inappropriate drug prescriptions and prescription omissions in paediatrics was the first tool to be published in this field in 2014. Our aim was to update the POPI tool for French use based on current recommendations and practice. Criteria were removed, updated or added based on recommendations from learned societies and national bodies. The two-round Delphi method was used to reach a consensus of experts. The level of agreement of the healthcare professionals' proposals was rated on a 9-point Likert scale. In the first round, only proposals with a median agreement of 7 to 9 and an agreement of more than 65% were retained. In the second round, only those with a median agreement of 7 to 9 and over 75% agreement were retained. The POPI tool now includes eight categories (various, infectiology, gastroenterology, pneumonology, dermatology, neurology/pedopsychiatry, haematology and excipients). All the criteria were supported by bibliographical references. They were submitted to 20 French healthcare professionals: 9 pharmacists and 11 doctors (17 hospital-based and 3 self-employed). After two rounds of Delphi testing, 166 criteria were retained and validated (111 inappropriate prescriptions and 55 omissions). In conclusion, this study made it possible to update the POPI tool, which is still available for assessing paediatric prescriptions.

[What is the cross-disciplinary pathway for a patient receiving gene therapy?] / Quel parcours transversal pour un patient recevant une thérapie génique ?

The Department of Hematology-Immunology, headed by Professor Jean-Hugues Dalle, is the leading department in France for the care of patients receiving pediatric hematopoietic stem cell transplants. Since 2018, it has been a "major player" in the development of innovative treatments, such as gene therapy. To date, it is the only care service in France, which offers this treatment to stop the neurodegenerative progression of two genetic diseases, in collaboration with the neuropediatric service of the Kremlin-Bicêtre hospital headed by Prof Kumaran Deiva, in conjunction with the national reference center for rare disaeses didicated to leucodystrophies. It is a complex care that requires all the actors a cooperation (parents-children-caregivers).

Applicability of the Socioecological Model for Understanding and Reducing Consumption of Ultra-Processed Foods in Canada.

Ultra-processed foods (UPFs) have become a major contributor to the diets of Canadians, with a recent report from Statistics Canada suggesting Canadians are consuming almost one-half of their calories from UPFs. Research has linked UPF consumption with increased risk for chronic diseases such as cardiovascular disease and type 2 diabetes, among others. This paper sought to investigate the popularity of UPFs, particularly among children and teens, utilizing the socioecological model as a framework to illustrate how influences at multiple levels (i.e., public policy, organizational, community, interpersonal, and individual) have played a role in the proliferation of UPFs. Evidence from previous studies is used to identify how factors at different levels may influence UPF consumption and discuss potential strategies for reducing UPF consumption. To meaningfully reduce UPF consumption among Canadians, all levels should be considered, with the goal of creating a healthier Canadian population.

La prise en charge de la neutropénie fébrile chez les enfants et les adolescents immunocompétents.

La neutropénie fébrile est une manifestation clinique fréquente en pédiatrie, qui peut être associée à une infection bactérienne invasive. Cependant, le risque de ce type d'infection est faible chez les enfants et les adolescents autrement en santé qui font de la fièvre et présentent une neutropénie, la plupart des cas étant causés par une infection virale. Les enfants âgés de six mois à 18 ans qui ont l'air bien, ne souffrent pas d'un cancer, sont considérés comme immunocompétents et présentent un premier épisode de neutropénie, sans autres facteurs de risque, n'ont généralement pas besoin d'antibiotiques empiriques. Cependant, une évaluation approfondie est indiquée, y compris une anamnèse et un examen physique complets, de même qu'une hémoculture lorsque la numération absolue des neutrophiles est inférieure à 0,5 × 109/L. Il est recommandé d'assurer un suivi étroit, de reprendre l'hémogramme et de donner des conseils préventifs stricts.

Les recommandations en vigueur pour la prise en charge de l'acidocétose diabétique pédiatrique.

Pour traiter l'acidocétose diabétique pédiatrique, il faut porter une attention particulière aux liquides et aux électrolytes pour limiter le risque de complications, telles qu'une lésion cérébrale, associée à une morbidité et une mortalité élevées. L'incidence d'œdème cérébral en cas d'acidocétose diabétique n'a pas diminué malgré les protocoles visant la limitation des liquides qui s'appuient sur la restriction de la réanimation liquidienne initiale. Selon de nouvelles données probantes, l'administration précoce de liquides isotoniques n'entraîne pas de risque supplémentaire et peut améliorer les résultats cliniques chez certains patients. Les protocoles et les directives cliniques sont adaptés et axés particulièrement sur la surveillance et le remplacement initiaux et continus des liquides et des électrolytes. Il est maintenant recommandé de commencer par une réanimation à l'aide de liquides isotoniques chez tous les patients dans les 20 à 30 minutes suivant leur arrivée à l'hôpital, suivie par la réplétion du déficit volumique sur une période de 36 heures, en association avec une perfusion d'insuline et des suppléments d'électrolytes, ainsi qu'avec la surveillance et la prise en charge attentives d'une éventuelle lésion cérébrale.

Une approche d'affirmation pour les soins aux jeunes transgenres et de diverses identités de genre.

Un nombre croissant de jeunes s'identifient comme transgenres ou de diverses identités de genre. De nombreux pédiatres et dispensateurs de soins de première ligne accueilleront cette population dans leur pratique, dans le cadre de soins liés au genre ou de soins de santé généraux. Le présent document de principes se veut une ressource pour orienter les pédiatres et les dispensateurs de soins de première ligne à adopter une approche d'affirmation pour la prestation des soins réguliers à tous les jeunes. De plus, il contient de l'information visant à aider les dispensateurs à répondre aux demandes de conseils des jeunes transgenres et de diverses identités de genre et de leur famille au sujet des possibilités de transition médicale et d'orientation vers des services spécialisés s'ils le désirent et le jugent pertinent. Enfin, on anticipe que la demande de soins d'affirmation de genre continue d'augmenter, et certains dispensateurs de soins peuvent souhaiter acquérir les connaissances et les habiletés nécessaires pour amorcer les inhibiteurs d'hormones et les hormones d'affirmation de genre chez les adolescents. Le présent document ne contient pas de directives cliniques, mais de l'information fondamentale au sujet des divers éléments possibles des soins d'affirmation de genre, tout en reconnaissant que les besoins et les objectifs d'adolescents particuliers n'incluent pas automatiquement de telles interventions. D'autres ressources permettant d'acquérir les compétences nécessaires pour offrir des interventions d'affirmation de genre sont également proposées.

Ultrasonography in the assessment of hand injuries in children: A systematic review.

Despite the frequency of paediatric hand injuries, recommendations for diagnostic investigations are limited due to paucity of published guidelines. This has led to inappropriate diagnoses and therefore inappropriate management. Ultrasonography is a portable, non-ionising imaging modality that allows rapid real-time evaluation of anatomical structures at a low cost and without sedation. In the adult population, ultrasonography has already been shown to improve accuracy in hand injury diagnoses. However, in the paediatric population, only one narrative review focuses on the application of ultrasonography to diagnose hand injury. A systematic search using PubMed, Google Scholar, EMBASE, Scopus, Cochrane database of systematic reviews and University Library of York, Keele, Edinburgh and King's College London was conducted to assess literature surrounding use of ultrasonography as a diagnostic tool for paediatric hand injuries. The literature search yielded 11,860 articles and 21 studies were identified with a total of 30 patients. Ultrasonography was observed to be an accurate tool for diagnosing bone, tendon, ligament and nerve injuries in children. The results of our study suggest that ultrasonography should be considered as an early diagnostic step for paediatric hand injuries.

[Outpatient surgery for penile hypospadias in pediatric urology: A monocentric experience with a mean follow-up of 3 years]. / Chirurgie ambulatoire de l'hypospade pénien pédiatrique : expérience monocentrique avec un recul moyen de 3 ans.

INTRODUCTION: Hypospadias is one of the most common congenital anomalies in men. Outpatient surgery has been proposed but is not widespread. The aim of this study was to evaluate our experience of outpatient surgery for penile hypospadias repair and to specify the constraints for a result similar to a conventional inpatient procedure. PATIENTS AND METHODS: Observational, retrospective and single-center study, including all the patients operated on hypospadias for the first time by one of the 3 senior surgeons, between January 2011 and March 2018. Peno-scrotal and perineal hypospadias were excluded because systematically hospitalized. RESULTS: One hundred sixty-six patients were included. 67 patients (40,4%) were treated on an outpatient basis. The mean age at the time of procedure was 15.6 (6-51) months. Forms with curvature were almost exclusively hospitalized (1 vs. 25, P<0.001). There was no significant difference for anterior penile forms (60 vs. 81, P=0.06). Middle and posterior hypospadias were more often hospitalized, although outpatient experience exists. There were no more complications in the outpatient group. CONCLUSION: Outpatient hypospadias surgery seems to be achievable in most of the cases, provided that medical care is standardized and multidisciplinary, the staff is trained and involved and a specific organization is put in place in the department. Evaluation of the socio-family environment is therefore fundamental.

[Illustrated case study of a patient with pediatric multisystem inflammatory syndrome]. / Cas clinique illustré autour d'un patient atteint d'un syndrome inflammatoire multisystémique pédiatrique.

Between November 2020 and June 2021, twelve children were treated at a university hospital in western France for pediatric multisystem inflammatory syndrome (PIMS). While the clinical presentation may have been reminiscent of Kawasaki disease, PIMS, a new nosological entity, was mentioned in the media in the context of the Covid-19 pandemic. In 2023, research into this syndrome will continue in France and Europe.

[History and challenges of the transition from pediatrics to adult care]. / Histoire et enjeux de la transition pédiatrie-soins d'adultes.

Transition from pediatrics to adult care involves a growing number of young people living with chronic health conditions. Now a field of study and practice, transition has been built up in successive stages, the nature of which informs us about its evolution and current issues.

[From palliative care... to the palliative approach in paediatrics: 10 years on]. / Des soins palliatifs... à la démarche palliative en pédiatrie : état des lieux 10 ans après.

There are 24 regional pediatric palliative care resource teams (ERSP) in metropolitan and overseas France. An initial review of the ERSPs was carried out in 2015. The ERSP commission of the Société française de soins palliatifs pédiatriques (French Society for Pediatric Palliative Care) wanted to review the situation again, ten years after the creation of these teams. This article presents the main findings.

Early relational health: Innovations in child health for promotion, screening, and research.

Relational experiences during infancy and early childhood are key drivers for building health, social emotional development, and learning capacities, each vital for wellbeing. The U.S. child health sectors share a commitment to universal health promotion, prevention and early intervention, and a growing enthusiasm for the research-affirmed primacy of caregiver-child interactions during the critical first 1000 days of life. Given our nation's growing children's mental health crisis, racial justice awakening and the need to reimagine equitable supports for young families post-COVID19, the child health sectors seek new tools and clinical approaches that blend science-to-practice innovations with co-developed activities that are meaningful to families. This special section brings together papers about a journey of co-discovery between researchers, clinicians, and parents during the development and refinement of new video- and interview-based dyadic relational screening and monitoring tools. The collection of papers addresses a range of topics including early relational health (ERH), development and validation of the Early Relational Health Screen, its application within research and clinical settings, and thoughtful discussions from multiple perspectives. Informed by the diversity informed tenets, this journey highlights not only science-informed approaches, but also co-development with families of equitable approaches to understanding and serving children and their caregivers.

Las experiencias en las relaciones durante la infancia y la temprana niñez son conductores claves para fortalecer la salud, el desarrollo socio-emocional y las capacidades de aprendizaje, todas las cuales son vitales para el bienestar. Los sectores de salud infantil en los Estados Unidos comparten un compromiso para promover globalmente la salud, la prevención y la temprana intervención, así como un creciente entusiasmo por la primacía de las interacciones entre quien presta el cuidado y el niño, tal como las reafirma la investigación, durante los críticos primeros mil días de vida. Dada la creciente crisis de salud mental infantil de nuestro país, el despertar de la justicia racial y la necesidad de volver a conceptualizar los apoyos equitativos para familias jóvenes después del Covid-19, los sectores de salud infantil, buscan nuevas herramientas y acercamientos clínicos que mezclan las innovaciones de la ciencia a la práctica con actividades desarrolladas en conjunto que resultan significativas para las familias. Esta sección especial presenta artículos acerca de una trayectoria de descubrimiento en conjunto entre investigadores, profesionales clínicos y padres durante el desarrollo y afinamiento de nuevas herramientas de detección y supervisión de la relación diádica basadas en videos y entrevistas. El grupo de artículos aborda un número de temas que incluyen la temprana saludable relación (ERH), el desarrollo y la validez de la Detección de la Temprana Saludable Relación, su aplicación dentro de los campos de la investigación y clínicos, así como sensatas discusiones a partir de múltiples perspectivas. Respaldada por principios basados en la diversidad, esta trayectoria subraya no sólo los acercamientos cuya información proviene de la ciencia, sino también el desarrollo en conjunto con familias de equitativos acercamientos para comprender y servirles a los niños y a quienes los cuidan.

Les expériences relationnelles le bas âge et la petite enfance sont des facteurs clés pour la construction de la santé, le développement socio-émotionnel et les capacités d'apprentissage, qui sont indispensables au bien-être. Les secteurs de la santé de l'enfant aux Etats-Unis d'Amérique partagent un engagement envers la promotion universelle de la santé, la prévention et l'intervention précoce, et un enthousiasme grandissant pour la primauté des interactions personne prenant soin de l'enfant-enfant, affirmée par les recherches, durant les 100 premiers jours critique de la vie. Au vu de la croissance de la crise de santé mentale des enfants dans notre pays, du réveil de la justice raciale et du besoin de réimaginer les soutiens équitables pour les jeunes familles après le Covid19, les secteurs de la santé mentale de l'enfant cherchent de nouveaux outils et des approches cliniques qui mélange des innovations science-à-pratique avec des activités élaborées conjointement qui sont utiles et ont un sens pour les familles. Cette section spéciale rassemble des articles sur un voyage de codécouverte entre des chercheurs, des cliniciens, et des parents durant le développement et le perfectionnement d'un nouveau dépistage relationnel dyadique à partir d'entretiens et de vidéos, et d'outils de suivi. Cette collection d'articles porte sur un éventail de sujets y compris la Santé Relationnelle Précoce (SRP), le développement et la validation du Dépistage de Santé Relationnelle Précoce, son application dans des contextes de recherche et dans des contextes cliniques, et des discussions attentionnées de perspectives multiples. Informé par des principes fondés sur la diversité, ce voyage met en évidence non seulement des approches scientifiques mais aussi des co-développements avec des familles d'approches équitables à la compréhension et au service des enfants ainsi que des personnes prenant soin d'eux.

[Chronic aqueous diarrhea in children: An unusual etiology]. / Diarrhée aqueuse chronique chez l'enfant : une étiologie à ne pas méconnaître.

Peripheral neuroblastic tumors are the most common extracranial solid tumors in children. On the other hand, diarrheal neuroblastic tumors are quite rare and not easy to diagnose in the early stage. We report a case of neuroblastic tumor in a 2-year old girl presenting with aqueous diarrhea caused by paraneoplasic secretion of VIP.

Les pratiques exemplaires pour l'évaluation et le traitement de la douleur chez les enfants.

L'évaluation et le traitement de la douleur sont des aspects essentiels des soins pédiatriques. L'évaluation de la douleur adaptée au développement représente une première étape importante pour en optimiser la prise en charge. L'autoévaluation de la douleur est à prioriser. Si c'est impossible, des outils appropriés d'évaluation du comportement, adaptés au développement, doivent être utilisés. Des directives et stratégies de prise en charge et de prévention de la douleur aiguë, qui combinent des approches physiques, psychologiques et pharmacologiques, doivent être accessibles dans tous les milieux de soins. Le meilleur traitement de la douleur chronique fait appel à une combinaison de modalités thérapeutiques et de counseling, dans l'objectif premier d'obtenir une amélioration fonctionnelle. La planification et la mise en œuvre de stratégies de prise en charge de la douleur chez les enfants doivent toujours être personnalisées et axées sur la famille.

Les tests et le dépistage génétiques chez les enfants.

Les tests génétiques, qui ont évolué rapidement depuis vingt ans, deviennent monnaie courante en pédiatrie. Le présent document de principes procure un aperçu des récents développements qui peuvent avoir des répercussions sur les tests génétiques chez les enfants. La génétique est un domaine en constante évolution, et le présent document de principes s'attarde tout particulièrement au dépistage néonatal élargi, au séquençage de nouvelle génération, aux découvertes fortuites, aux tests commercialisés directement auprès des consommateurs, aux tests d'histocompatibilité et aux tests génétiques dans le contexte de la recherche.

[Development of a tool to help optimizing drug prescriptions in pediatric units in Côte d'Ivoire: GOPP tool]. / Développement d'une grille d'aide à l'optimisation des prescriptions médicamenteuses en pédiatrie en Côte d'Ivoire : outil GOPP.

OBJECTIVE: This study aims to develop a tool for optimizing drug management related to clinical and therapeutic contexts of pediatric units in Côte d'Ivoire. METHODOLOGY: A list of Inappropriate prescribings (IPs) was developed from prescription review of inpatients and outpatients aged 1 month to 15 years and followed in pediatric units at 4 Teaching Hospitals of Abidjan during 16 months. A two-round Delphi method was used to validate a qualitative list of IPs by experts according to their level of agreement on a six-point Likert scale of 0-5 (0, no opinion; 5, strongly agree). Only propositions obtaining the agreement (rating 4 or 5) of>70% of experts who gave a non-zero rating for the first round and 80% for the second round were retained. Each IP of final list associated with "rationale", (justifying the inappropriateness of prescribing), and "recommendations and/or therapeutic alternative", used to elaborate items of a tool for helping to optimize drug prescriptions in pediatrics (GOPP tool). RESULTS: A qualitative list of 54 IPs was drawn up from 267 Drug related problems detected after prescription review of 4992 prescription lines for 881 patients. Twenty-three (23) experts rated IPs on this list during two-round Delphi survey. At the end of survey, final list of 52 IPs was retained for development GOPP tool items. Malaria (15%), rhinitis (12%) and bacterial infectious (8%) are mainly pathologies concerned by these items. CONCLUSION: GOPP tool developed in this study should help to improve drug management of patients in pediatric units in Côte d'Ivoire.

[Pediatric exposure to endocrine disruptors and carcinogenic, mutagenic or reprotoxic substances by pharmaceutical forms intended for the cutaneous route: Regulatory provisions in France, in Europe, and state of the art of scientific knowledge]. / Exposition pédiatrique aux perturbateurs endocriniens et substances cancérogènes, mutagènes ou reprotoxiques par des formes pharmaceutiques destinées à la voie cutanée : dispositions réglementaires en France, en Europe, et état de l'art des connaissances scientifiques.

OBJECTIVES: The objective is to conduct a review of pediatric exposure to substances whose endocrine disrupting (ED), carcinogenic, mutagenic, or reprotoxic (CMR) character has been confirmed or remains controversial, through their use in pharmaceutical forms intended for the cutaneous route, as well as regulatory measures diligent at the national and European levels. METHODS: A bibliographical search was carried out on the databases PubMed, Web of Science, Cochrane Library, supplemented by a search for recommendations from French and European authorities. References were selected following an assessment of their relevance to our topic. RESULTS: Seventy-one references were selected. Pediatric exposure to endocrine disruptors and CMR substances remains through products formulated for their use, but also through indirect exposure to products commonly used by adults. Exposure arises both from the choice of excipients (parabens, phenoxyethanol), packaging materials (bisphenols, phthalates) and the qualitative or quantitative nature of the active ingredients (iodine, boron, pyrethroids, organic sunscreens). CONCLUSION: The health professional must be able to develop a critical mind on such substances in order to inform and promote therapeutic adherence, guaranteeing the safety of the child's care.

[Satisfaction of parents of children hospitalized in pediatrics in Togo]. / Satisfaction des parents d'enfants hospitalisés en pédiatrie au Togo.

In order to evaluate the degree of satisfaction of parents of children treated in the pediatric service of the Sylvanus-Olympio University Hospital of Lomé (Togo), a cross-sectional and analytical study was conducted from August 1 to 31, 2020, among 300 parents. The sociodemographic aspects of the families and those related to their perception of the care provided in the service were evaluated. Overall, the families were satisfied with the reception and the care their child received.