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).

[Pediatric myasthenia with ocular involvement]. / Myasthénie chez l'enfant avec atteinte oculaire.

PURPOSE: Myasthenia is a rare disease in children, with an estimated incidence of 1 to 5 per million children. However, the potential severity of its consequences and the existence of specific treatments require prompt diagnosis by pediatric ophthalmologists. METHODS: Retrospective review of patient records. Patients were identified from a rare disease database. Patients under the age of 18 years with confirmed diagnosis of myasthenia and ocular symptoms seen in a specialized clinic between 2005 and 2021 were included. RESULTS: Twenty-six (16 girls) with confirmed myasthenia and ocular symptoms were included. Ten patients had definite autoimmune myasthenia gravis (AIMG); 6 had suspected AIMG with negative antibody testing. Six patients had definite congenital myasthenic syndrome (CMS); 4 had suspected CMS with no evidence of mutation. Mean age at diagnosis of myasthenia was 5 years-3 years and 5 months for CMS and 6 years and 3 months for AIMG. Male to female (M:F) ratio was 6/10 for autoimmune myasthenia gravis and 4/6 for CMS. Ptosis was present in all cases; strabismus in 21 patients (68%). The clinical forms of myasthenia were ocular myasthenia in 12 patients (10 AIMG and 2 CMS), generalized in 12 patients (7 CMS and 5 AIMG) and secondary generalization of ocular myasthenia in 2 patients (2 AIMG). DISCUSSION: These results are based on only 26 cases, which can be explained by the rarity of this diagnosis in children. As in adults, the first signs are often ophthalmologic - ptosis alone or associated with strabismus. Diagnosis is difficult because of the absence of clinical signs, laboratory tests or electrophysiological signs with high sensitivity. Thus, the work-up may remain completely negative in secondarily proven forms. In addition, electroneuromyograms and oculomotor recordings in small children are more difficult to perform than in adults. For these reasons, the clinical examination is essential. In the case of strong suspicion, all additional medical examinations are carried out in a day unit, in order to reach a positive diagnosis of myasthenia. The so-called "congenital" forms, which are genetic, are proportionately higher than in adults, and diagnosis and treatment are often more difficult than in the classic autoimmune forms. CONCLUSION: Myasthenia can affect children from a very young age and can present as ptosis, initially isolated or associated with strabismus. Diagnosis and treatment may be difficult and should be organized in specialized centers.

Nuclear protein in testis (NUT) midline carcinoma of the larynx: A rare case report of a paediatric patient and literature review.

Nuclear protein in testis (NUT) carcinoma is a rare neoplasm arising mainly from midline structures. It is an aggressive type of carcinoma associated with poor survival despite the use of multiple treatment modalities. Here, we present a case of a 17-year-old paediatric patient with NUT carcinoma of larynx, which is even rarer among all reported cases. The patient underwent surgery followed by radiotherapy and systemic treatment and he died 15 months after the diagnosis. The management of this rare disease requires further investigation.

Intraocular foreign bodies in children: A retrospective case series.

INTRODUCTION: Open globe injuries are a major cause of visual impairment in children, related to the severity of the trauma or secondary to induced amblyopia. Intraocular foreign bodies (IOFB) have been reported in approximately one third of cases of open globe injuries. As clinical presentation and management may differ between adults and children, data is lacking about IOFBs in children under 18years of age. The purpose of this study was to assess the clinical characteristics and visual prognosis of ocular trauma associated with intraocular foreign bodies in children. MATERIALS AND METHODS: This single-center retrospective study included patients under 18years of age treated for ocular trauma with IOFB. Demographic characteristics, complete initial and final ophthalmological examination, imaging data and details of medical and surgical management were collected. RESULTS: Fourteen patients were included (78.6% boys), with a mean age of 10.3years (min 7months-max 17years). In 92.9% of cases, patients were found to have a single IOFB, mostly metallic (71.4%). Posterior segment IOFBs were found in 50% of cases, anterior segment IOFBs in 28.6% and orbital IOFBs in 21.4%. The clinical examination permitted detection of the IOFBs in 50% of cases, while they were visible on CT scan in all cases. The mean initial visual acuity was 20/320, and the mean final visual acuity was 20/125. Endophthalmitis occurred in 2 cases (14%). DISCUSSION: Open globe injuries associated with IOFB are severe and sight-threatening. Localization of the IOFB in the posterior segment has a worse prognosis. CT scan is mandatory, especially in children, as the trauma history is often missing. Retinal detachment and endophthalmitis appear to be the main prognostic factors requiring urgent specialized pediatric ophthalmology management.

Type 1 Diabetes in Ontario Schools: Policy and Practice.

OBJECTIVES: Type 1 diabetes (T1D) is a challenging chronic condition. Young children with T1D require daily support to manage their condition while at school. In 2018, Ontario established a provincial policy to ensure safe and equitable school participation for children with diabetes. Despite this, children and parents describe very different school experiences. In this qualitative study we describe the interpretation and implementation of school board policy related to the care of children with T1D from the perspective of school educators (principals/teachers). METHODS: Policy documents were reviewed employing a qualitative descriptive research design using directed qualitative content analysis. Semistructured interviews were conducted with 13 teachers and principals from 10 publicly funded elementary schools across the Hamilton and Toronto District School Boards in 2021. RESULTS: There are major differences in how policies regarding T1D are being implemented in schools. This includes how school staff are educated about T1D, and how they interpret and act on blood glucose information. Although educators often play an active role in supporting children, many face barriers, including competing priorities, fear, lack of information, and lack of support. Facilitators include effective communication/collaboration, actionable information, time, and a diabetes "champion." In some instances, access to nursing support could help to resolve barriers or create care gaps. CONCLUSIONS: School board policy provides high-level guidance on how to support children with T1D in school, but gaps remain. We provide specific recommendations regarding policy, staff education/training, roles and responsibilities, and future research.

Uveitis following COVID-19 vaccination in the pediatric population: Experience at a tertiary referral hospital.

OBJECTIVE: To determine the incidence and outcomes of uveitis following coronavirus (COVID-19) vaccination in the pediatric population. METHODS: A case series of all patients under the age of 18years diagnosed with uveitis within 28days of COVID-19 vaccination. RESULTS: Out of 33 patients under the age of 18years who presented with uveitis from July 2021 until May 2022, eight (24.2%) developed uveitis following COVID-19 vaccination within 28days. Four had a previous history of uveitis. The mean time interval from COVID-19 vaccination to uveitis diagnosis was 14.75days. The most common anatomic diagnosis was anterior uveitis in four children, followed by panuveitis in two and posterior uveitis in two. Seven children were treated with systemic steroids/immunomodulatory agents. Improved or unaffected visual acuity was noted in all children at the final follow-up. CONCLUSION: The pediatric population may demonstrate uveitis following COVID-19 vaccination. All children were treated successfully, and good final visual acuity was achieved.

[Pulmonary function test: The testing of children]. / Exploration fonctionnelle respiratoire : explorer l'enfant.

In paediatrics, the pulmonary function test (PFT) is most often performed to support the diagnosis or in follow-up of asthma patients. Whatever the pathology responsible for respiratory symptoms and/or functional impairment, repeated PFTs make it possible to establish a prognosis (pulmonary function trajectories…) and to orient preventive interventions. PFT can be performed routinely from the age of three years, provided that the following requirements are met: suitable techniques and equipment, staff trained to apply the techniques and to receive young children, reference values for each technique indicating the limits of normal values and of between-test significant variation. From the age of three, children can be subjected to tidal breathing measurement of: resistance of the respiratory system (oscillometry, Rrs; airflow interruption, Rint) or of airways specific resistance (sRaw) and functional residual capacity (by applying a dilution technique). With maturity, the child will become capable of mobilizing his or her slow vital capacity to measure total lung capacity (TLC), once again by applying a dilution technique, then later by breathing against a closed shutter (plethysmography TLC and Raw). Finally, the child will be able to carry out forced expiration (forced spirometry) along with all of the other PFTs. It is important to take into account the paediatric adaptations specified in the international recommendations regarding the performance, reproducibility and quality of PFTs targeting this population.

[Pediatric aphereses (workshop SFGM-TC)]. / Cytaphérèses pédiatriques (atelier SFGM-TC).

Practice of pediatric aphereses - in particular when caring for low-weight children - differs from the practice of adult aphereses, since pediatric aphereses represent low numbers of procedures, which has practical implications in terms of practical training and retraining for involved healthcare personnel, as needed for habilitation and validation of ongoing competencies. A specific training is mandatory in order to ensure both the child and the staff safety during and after collection, as well as ensure high quality of the collected cell product and that its meets predefined specifications that depend on its intended use. Low and very low-weight children deserve a particular attention for a number of procedural and clinical aspects: the nature and quality of venous accesses to ensure proper operation of the cell separator, management of hemodynamic fluctuations in relation with the relative importance of the extracorporeal blood volume as compared to the total blood volume of the child, risks and clinical manifestations of citrate toxicity, minimization of stress during the procedure that may include but is not limited to pharmacological sedation. The full spectrum of competencies needed to deal with these aspects is rarely present within a single team of healthcare professionals; it most often requires the tight combination of expertise drawing from the collection facility, the pediatric department and possibly the pediatric intensive care unit ward, whether from the same or from different institutions. Interactions must be formalized in a document that accurately describes which category of actors is responsible for each category of acts (prescriptions, decisions), depending on their initial qualifications, specific competencies, and affiliations.

[Chemotherapy-induced nausea and vomiting in pediatric oncology patients: 2023 recommendations from the Supportive Care Committee of the French Society of Cancer in Children and Adolescents]. / Nausées et vomissements chimio-induits en oncohématologie pédiatrique : actualisation 2023 des recommandations du comité soins de support de la SFCE.

Chemotherapy-induced nausea and vomiting (CINV) are frequent and dreaded side effects in cancer treatments. CINV has a major impact on patient's condition and quality of life. Prophylaxis is tailored to patient's profile and the emetogenic level of their chemotherapy. The aim of this study is to update the recommendations for CINV prevention and management in pediatric onco-hematology for use in France, by adapting the guidelines of the Pediatric Oncology Group of Ontario (POGO). Clinical practice guideline adaptation is a recognized method for tailoring existing clinical practice guidelines to local context. A multidisciplinary French-speaking panel was formed to discuss about POGO guideline recommendations for the acute and delayed phases, breakthrough, refractory and anticipatory CINV and the evidence supporting them. Panel members were asked whether they wanted to adopt, modify or reject each of the POGO guideline recommendations. Panel members translated each recommendation and adapted recommendations for an implementation in France. Their acceptance required agreement at least 80 % of panel members. Algorithms and tables were created, listing all the recommendations and providing a better overview for decision-making process adapted to the patient's profile. These recommendations should be reviewed for implementation at French institutions caring for pediatric cancer patients and once implemented, the rates of adherence to recommendations and CINV control should be reported.

Association of Fructosamine Levels With Glycemic Management in Children With Type 1 Diabetes as Determined by Continuous Glucose Monitoring: Results From the CGM TIME Trial.

OBJECTIVE: Our aim in this study was to determine the correlation between serum fructosamine and average blood glucose, as measured by continuous glucose monitoring (CGM) in children with type 1 diabetes. METHODS: Ninety-seven blood samples were collected from 70 participants in the Timing of Initiation of continuous glucose Monitoring in Established pediatric diabetes (CGM TIME) Trial. Each eligible participant had 3 weeks of CGM data with at least 60% CGM adherence before blood collection. Ordinary least-squares linear regression incorporating restricted cubic splines was used to determine the association between fructosamine levels and mean blood glucose. RESULTS: An association was found between fructosamine and mean blood glucose, with an F statistic of 9.543 (p<0.001). Data were used to create a formula and conversion chart for calculating mean blood glucose from fructosamine levels for clinical use. CONCLUSIONS: There is a complex relationship between average blood glucose, as determined by CGM and fructosamine. Fructosamine levels may be clinically useful for assessing short-term glycemic management when CGM is not available.

Pediatric Performance-Based Outcome Measures for Upper Extremity Function: A Scoping Review and Linking to the International Classification of Functioning, Disability, and Health.

Background. Performance-based outcome measures (PBOMs) are objective measures that assess physical capacity or performance in specific tasks or movements. Purpose. 1) to identify which PBOMs are most frequently reported to evaluate upper extremity (UE) function in pediatric rehabilitation 2) to determine the link between constructs of the ICF and meaningful concepts extracted from each identified PBOM. Methods. Pediatric UE PBOMs were searched in four databases. The selection of outcome measures included an initial title and abstract screening, followed by full-text review of the articles to be included based on identified selection criteria. Two reviewers were appointed to link the meaningful concepts identified in the outcome measures independently and a third reviewer was consulted in case of ambiguity to make a final decision. Findings. After the initial screening, 1786 full-text articles were reviewed, 1191 met the inclusion criteria, in which 77 outcome measures were identified and 32 were included in the linking process. From the included 32 outcome measures, 538 items were extracted and linked to the ICF. The most commonly cited measures included Assisting Hand Assessment, Jebsen-Taylor Hand Function Test, Melbourne Assessment of Unilateral Upper Limb. The Activity and Participation domain represented 364 codes followed by the Body Functions domain domain which represented 174 codes. Implications. A majority of the outcome measures identified were linked with the Mobility, Fine Hand Use of the ICF. Therefore, when selecting a PBOM, careful considerations need to be made regarding which concept of health is to be assessed.

[Knowledges And Practices Of Iron Prescription By The Pediatric Ward In CHU Gabriel Touré Of Bamako, Mali]. / Connaissances Et Pratiques De La Prescription Du Fer Par Le Personnel Du Service De Pediatrie Du Chu Gabriel Toure De Bamako.

GOAL: To assess knowledges and practices on iron prescription in pediatric ward in CHU Gabriel Touré of Bamako, Mali. TOOLS AND METHODS: It was a prospective and transversal study canied out. We submitted questionnaire and analyzed the case history of to the children aged 1-60 months old who received iron during the study period from 1rstto 30 July 2012. The prescriptators' consent were solicited and obtained at first of all. RESULTS: Fifty prestators were interviewed among them 10 pediatricians (20%), 31 pediatrics' resident (62 %), 2 generalists physicians (4%), 7 medical student (14%). One hundred 100 were analyzed medical records. More than half of the prestators known the need of iron in children. Thirty percent have received iron at 8 to 10mg/kg. The medication duration wasn't indicating in 92% of patients. In our context prestators well know about meaning and the needs of iron in children bout they're limited on iron food sources and iron storage. CONCLUSION: The well theorical knowledge on indications and prescription roules on iron in children didn't escape from miss practices in its prescription. Moreover works should analyze the reasons of discrepancies.

BUT: Evaluer les connaissances et les pratiques relatives à la prescription du fer dans le service de pédiatrie du Centre Hospitalier Universitaire Gabriel Touré (CHU-GT) de Bamako, Mali. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale réalisée du 1 er au 30 Juillet 2012 à la pédiatrie. Nous avons soumis un questionnaire aux prestataires et analysé les dossiers des enfants âgés de 1 à 60 mois hospitalisés ayant reçu du fer. Le consentement des prescripteurs à été demandé et obtenu au préalable. RÉSULTATS: nous avons enquêté cinquante prestataires dont 10 pédiatres (20%), 31 médecins CES de pédiatrie (62 %), 2 médecins généralistes (4%), 7 étudiants en fin de cycle médical (14%) et analysé 100 dossiers. Trente pour cent des prestataires ont correctement défini le fer. Plus de la moitié des prestataires connaissaient les besoins en fer chez l'enfant. Les réserves en fer étaient connues de 42% des prestataires. Huit pour cent des prestataires savaient que les fers apportés par l'alimentation étaient le fer héminique ou le fer non héminique. Trente pourcent des malades ont reçu le fer à la dose de 8 à 10mg/kg. La durée du traitement n'a pas été précisée chez 92% des malades. CONCLUSION: Dans notre contexte la bonne connaissance théorique des indications et des règles de prescription du fer chez l'enfant n'excluait pas les mauvaises pratiques de sa prescription. D'autres travaux devraient analyser les raisons de cette discordance.

[Newborns dermatitis: about 116 cases collected in a university hospital in abidjan]. / Les dermatoses neonatales : a propos de 116 cas colliges dans un hopital universitaire d'abidjan.

AIMS: To determine the epidemiological profile of newborn dermatitis and to describe the different clinical aspects of the observed neonatal dermatitis. PROCEDURE: The study took place at the University Hospital of Cocody (Abidjan). The study was cross-sectional, descriptive and analytical, carried out on the basis of prospective recruitment. The study included newborns who were seen in outpatient or inpatient settings by 4 april 2018 to 23 August 2018 and in whom the pediatrician had observed cutaneous and/or mucosal lesions. The diagnosis was made with the collaboration of a dermatologist. RESULTS: During the study period, 116 newborns were identified. The age of the patients seen in pediatrics with dermatitis varied from 1 to 28 days, with a mean of 16.86 ± 8.4 days. The median age was 19 days. The most representative age range (32.8%) was 24-28 days. The sex ratio (M/F) was 1. In almost 2/3 of the cases, the children were born at term, 29.3% were premature and 5.2% were born after term. In almost 2/3 of the cases (63.8%), the newborns had a birth weight of more than 2500 g. Only 3.4% of newborns seen in pediatric consultations were referred for a dermatitis. The age of the lesions at the time of consultation varied from 1 to 26 days, with a mean of 06.19 days ± 5.13. In more than half (53.5%) of the cases, the lesions had evolved for less than 5 days. Transient dermatitis was more frequent (51.7%), followed by infectious dermatitis (32.8%). Transient dermatitis of the newborn was dominated by sweaty miliaria (40%). Infectious dermatitis were mainly represented by mycotic (68.4%) and bacterial (31.9%) infections. Bacterial dermatitis were composed of neonatal impetigo (83.3%) and folliculitis (16.7%). In almost half of the cases (46.1%) the mycotic dermatitis were represented by candidosis intertrigo and in 38.5% of the cases there was oral candidiasis. The other neonatal dermatitis observed were dominated by diaper rash (64.3%) (Photo 2) and congenital nevi (21.5%). More than half (57.1%) of the cases of toxic erythema neonatorum occurred between days 6 and 10 of life. Nearly half (41.6%) of the cases of sudoral miliaria occurred between birth and day 5 of life. More than half (57.1%) of the cases of sebaceous hyperplasia occurred before the 5th day of life. All cases of neonatal scaling and mongoloid spots were already present between birth and day 5 of life. The mean age of patients with transient dermatitis was 14.31 days compared with 19.41 days for those with the other dermatitis. The difference in age was statistically significant (p < 0.05). The transient dermatitis predominated in male neonates while the other dermatitis predominated in females, however the difference observed at the level of sex was not statistically significant (p > 0.05). CONCLUSION: The diagnosis of neonatal dermatitis is not always obvious, especially on black skin where few publications have been published.

OBJECTIFS: Déterminer le profil épidémiologique des dermatoses du nouveau-né et de décrire les différents aspects cliniques des dermatoses néonatales observées. MATÉRIEL ET MÉTHODES: L'étude s'est déroulée au Centre hospitalier universitaire de Cocody (Abidjan). L'étude était transversale, à visée descriptive et analytique, réalisée sur la base d'un recrutement prospectif. Ont été inclus, les nouveau-nés ayant été vus en consultation externe ou en hospitalisationdu 4 avril 2018 au 23 août 2018 chez qui le médecin pédiatre avait observé des lésions cutanées et/ou muqueuses.Ensuite,le diagnostic était posé par le dermatologue référant de l'étude. RÉSULTATS: Pendant la période d'étude, 116 nouveau-nés ont été recensés. La moyenne d'âge était 16,86 ± 8,4 jours avec un âge médian de 19 jours. Lesex ratio (H/F) était de 1. Dans plus de la moitié (53,5%) des cas, les lésions évoluaient depuis moins de 5 jours. Une dermatose transitoire était diagnostiquée dans plus de la moitié des cas (51,7%) et dans près du tiers des cas (32,6%) une dermatose infectieuse. Les dermatoses transitoires du nouveau-né étaient dominées par la miliaire sudorale (40%), l'érythème toxique (23%), la desquamation néonatale (10,7%) et l'hyperplasie néonatale (10,7%).Les taches mongoloïdes représentaient3,3% des cas. Les dermatoses infectieuses étaient essentiellement représentées par des infections mycosiques (68,4%) et bactériennes (31,6%). Les autres dermatoses néonatales observées étaient dominées par dermite du siège (64,3%) et les nœvi congénitaux (21,5%). Plus de la moitié (57,1%) des cas d'érythème toxique néonatal survenaient entre le 6e et le 10e jour de vie. L'âge moyen des patients présentant une dermatose transitoire était de 14,31 jours contre 19,41 jours pour ceux présentant les autres dermatoses. La différence observée au niveau de l'âge était statistiquement significative (p < 0,05). CONCLUSION: Les dermatoses néonatales sont multiples et variées. Certaines sont transitoires, ne nécessitant pas toujours de prise en charge thérapeutique. Leur diagnostic n'est pas toujours évident pour le pédiatre d'où la nécessité d'une étroite collaboration entre pédiatres et dermatologues afin d'améliorer la démarche diagnostique et parfois thérapeutique.

Relações alimentares iniciais, uma investigação clínica Pediatria e psicanálise nutrindo vínculos: psychoanalysis and pediatrics nourishing links / Early feeding relationships, a clinical investigation: pediatría y psicoanálisis nutriendo vínculos / Relaciones alimentares tempranas, una investigación clínica: l'établissement de liens entre pédiatrie et psychanalyse / Les relations alimentaires initiales, une recherche clinique

Na interface psicanálise/pediatria e clínica/investigação, este artigo apresenta considerações acerca das dificuldades alimentares infantis em sua transitoriedade ou tendência à cristalização como possíveis indicadores de resiliência ou vulnerabilidade nas relações iniciais pais-bebê. Além de oferecerem um panorama da qualidade do vínculo, tais dificuldades podem evocar intensas ansiedades dos cuidadores, criando um círculo vicioso de recusa, evitações mútuas, intensidade projetiva e desinvestimento na subjetivação que pode permear a dimensão mais ampla do desenvolvimento psíquico do bebê. Resultados de estudo clínico detalhado e material ilustrativo, são consideradas em seu processo de captação psicanalítica e propostas como categorias para identificação de vulnerabilidade emocional na relação pais-bebê e encaminhamento de famílias em necessidade de intervenção terapêutica, o mais cedo possível, por parte de profissionais de saúde em contexto pediátrico.

Within the interface psychoanalysis/pediatrics and clinical work/research, this paper presents considerations about early feeding difficulties in its transience or crystallization trends as possible signs of resilience or vulnerability within parent-infant relationship. In addition to providing an overview of the relationship quality, these difficulties can evoke intense anxieties of caretakers, creating a vicious circle of mutual avoidance, refusal, projective intensity and disinvestment in the subjectivities which can permeate the wider dimension of the baby's psychic development. Results of a detailed clinical study with illustrative material are considered in its initial investigation phase and proposed as categories for identification of emotional vulnerability within parent-infant relationship and early referral of families in need of therapeutic intervention by health professionals in pediatric context.

En la interfaz psicoanálisis/pediatría y clínica/investigación, este trabajo presenta consideraciones acerca de las dificultades de alimentación infantiles en su fugacidad o cristalización de tendencias como posibles indicadores de resiliencia o vulnerabilidad inicial en las relaciones padres-bebé. Además de proporcionar una visión general de la calidad del enlace, estas dificultades pueden evocar intensas angustias en los cuidadores, creando un círculo vicioso de evitación mutua, negación, intensidad proyectiva y desinvestidura en la subjetivación que puede impregnar la dimensión más amplia del desarrollo psíquico del bebé. Resultados de un estudio clínico detallado, con material ilustrativo, son considerados en su proceso psicoanalítico inicial y propuestos como categorías para identificación de vulnerabilidad emocional en la relación padres-bebé y encaminamiento de familias a intervención terapéutica, tan pronto como sea posible, por parte de profesionales de la salud en contexto pediátrico.

Dans l'articulation entre psychanalyse/pédiatrie et recherche/clinique, cet article présente des considérations sur les difficultés alimentaires infantiles transitoires ou avec des tendances de cristallisation. Ces difficultés indiquent des potentiels de résilience ou de vulnérabilité dans les premières relations parents-bébé. Ce cadre offre un panorama de la qualité du lien de la relation, bien qu'il peut évoquer des angoisses intenses par les soignants, ce qui peut créer un cercle vicieux de d'évitement mutuelle dans la relation. La cristallisation des aspects transitoires peut jouer un rôle important dans une dimension plus large du développement psychique du bébé. Les résultats détaillés et les illustrations cliniques de l'étude sont proposés comme des catégories pour l'identification de la vulnérabilité émotionnelle de la relation parents-bébé. En plus, ces catégories peuvent être utilisés par les professionnels de la santé pour adresser les familles à une intervention thérapeutique le plus tôt possible.

O psicanalista no tratamento da dor / The psychoanalyst in the treatment of pain / Le psychanalyste et le traitement de la douleur / El psicoanalista en el tratamiento del dolor

A dor se manifesta como mal-estar do corpo e no corpo, e tende a ser encaminhada para tratamento médico. O objetivo deste trabalho é analisar a queixa dolorosa do ponto de vista do tratamento psicanalítico, retomando algumas acepções relacionadas ao tratamento da dor, encontradas na obra de Freud. Partimos da experiência no trabalho em hospital pediátrico, utilizando a análise do atendimento de pacientes com queixas de dor para definir e situar a dor no campo da psicanálise, e distingui-la do campo da medicina. No texto, pode-se acompanhar a dor como signo de sofrimento e diversas formas de abordá-la tanto pelo sujeito que a porta quanto pelas instituições que propõem seu cuidado.

Pain is expressed can be described as physical discomfort and is usually treated medically. In this article we analyze complaints of pain from a psychoanalytic perspective, taking into account several Freudian concepts. We base the article on experiences in a pediatric hospital, related to the treatment of patients with complaints of pain, in order to define and situate pain in the psychoanalytic field and distinguish it from the field of medicine. In the text, pain can be seen as a sign of suffering, and there are various ways to treat it, both from the point of view of the person who feels it and from that of the institutions that propose to treat it.

La douleur se manifeste comme mal physique et par le physique et on a tendance à recourir au traitement médical pour s'en affranchir. L'objectif de ce travail est d'analyser la plainte de la douleur du point de vue du traitement psychanalytique en reprenant quelques acceptions sur le traitement de la douleur dans l'œuvre de Freud. Nous prenons comme point de départ le travail dans un hôpital pédiatrique et en analysons les plaintes de douleur pour définir et situer la douleur au domaine de la psychanalyse et la distinguer du domaine de la médicine. La douleur peut donc être interprétée comme signe de souffrance et nous disposons de plusieurs façons de la traiter, non seulement par le sujet, mais aussi par les institutions qui en prennent compte.

El dolor se manifiesta como malestar del cuerpo y en el cuerpo y, tiende a ser derivado para un tratamiento médico. El objetivo de este trabajo es analizar la queja de dolor desde el punto de vista del tratamiento psicoanalítico, retomando algunos conceptos referidos al tratamiento del dolor presentes en la obra de Freud. Partimos de la experiencia del trabajo en hospital pediátrico, usando el análisis del tratamiento a pacientes que se quejan de dolor para definir y situar el dolor en el campo del psicoanálisis, distinguiéndolo del campo de la medicina. En el texto se puede acompañar el entendimiento del dolor como una señal de sufrimiento y las diversas formas de abordarlo, tanto por el sujeto que lo sufre como por las instituciones que proponen su cuidado.

Jogos teatrais na pediatria, brincando com os objetos do teatro: dispositivos para cuidar / Theatrical games in pediatrics, playing with theater objects: devices for caring

Este trabalho está associado à pesquisa de mestrado profissional intitulada JOGOS TEATRAIS NA PEDIATRIA, BRINCANDO COM OS OBJETOS DO TEATRO: dispositivos para cuidar. A pesquisa foi realizada a partir das questões norteadoras: Como identificar nos jogos teatrais o significado das imagens produzidas pelas crianças no vídeo ou nos desenhos sobre a experiência de internar? Os significados das imagens ou desenhos podem ser indicadores de respostas para o cuidado em pediatria? Os objetivos foram: Identificar o que os jogos teatrais provocam na criança, ao criarem cenas e/ou desenhos sobre suas experiências da internação; destacar, nas cenas/imagens produzidas pelas crianças depois das atividades do jogo teatral, informações sobre sua experiência de internação. A metodologia da pesquisa é descritiva, observacional com caráter qualitativo, por produção de dados que indicassem significados sobre a experiência do brincar/jogar das crianças internadas. O jogo foi realizado com treze crianças, no qual 11 crianças estavam tristes e com dor, e duas estavam indiferentes antes de jogar/brincar. Depois das atividades do jogo, 12 crianças se apresentaram alegres e uma se manteve indiferente. Após a realização da organização da análise, destacam-se duas categorias centralizadas em relação ao estado emocional: a) as crianças se mostraram tristes antes de jogar; b) as crianças mostram alívio da dor após o jogar/brincar na internação. A conclusão deste estudo é que o brincar dentro de um hospital torna-se elemento importante para o desenvolvimento, saúde e bem-estar da criança enferma; as imagens produzidas falam do espaço de casa e do hospital, onde o segundo só é bom porque podem brincar/jogar e pintar como se estivessem em sua própria casa. Verificou-se também que os jogos cênicos podem contribuir atuando como ferramenta facilitadora no processo de cuidar da criança, além de auxiliar no resgate de algo tão natural e necessário na infância: o brincar. O jogo teatral favorece a liberação de conteúdos ocultos e emergentes, por meio da brincadeira, não se constituindo somente como instrumento para brincar, mas como ação terapêutica para diminuir a tensão, estresse e sofrimento decorrente da hospitalização. E, por fim, percebeu-se que a arte compõe o conjunto de ações do cuidado na saúde

Ce travail est lié au programme de recherche du Master professionnel intitulé LES JEUX THÉÂTRAUX À LA PÉDIATRIE, JOUER AVEC LES OBJETS DU THÉÂTRE: dispositifs pour le soin. Il a été réalisé à partir de questionnements spécifiques: Comment identifier dans les jeux théâtraux, la signification des images produites par les enfants dans la vidéo ou dans les dessins autour de l'expérience de l'internation ? Les significations des images ou des dessins peuvent être des indicateurs de réponses pour le soin dans la pédiatrie ? Et par rapport aux objectifs: identifier ce que les jeux théâtraux provoquent chez l'enfant à partir de la création de scènes et/ou de dessins sur leurs expériences d'internation; Remarquer dans les scènes/images produites par les enfants, les informations sur l'expérience de l'internation après les activités du jeu théâtral. La méthodologie de la recherche a eu un caractère qualitatif par production de données qui indiquent des significations sur l'expérience du jeu par les enfants hospitalisés. Le jeu a été réalisé avec treize enfants, dont onze étaient tristes et avec douleur et deux étaient indifférents avant de jouer. Après les jeux, douze enfants sont devenus contents et un enfant a continué indifférent. Après l'organisation de l'analyse, nous avons défini deux catégories par rapport à l'état émotionnel: a) Les enfants sont tristes avant de jouer. b) Après avoir joué dans l'internation, les enfants présentent un soulagement par rapport à la douleur. Nous arrivons ainsi à la conclusion que jouer dans un hôpital est un élément important pour le développement, la santé et le bien-être de l'enfant malade ; les images produites montrent un discours sur la maison et sur l'hôpital, où le deuxième est seulement agréable parce qu'ils peuvent y jouer et peindre comme s'ils étaient à la maison. On a pu vérifier aussi que les jeux scéniques peuvent contribuer comme outil facilitateur dans le processus de soin de l'enfant, et aussi comme auxiliaire dans la récupération de ce qui est si naturel et nécessaire à l'enfance : le jouer. Le jeu théâtral favorise la libération des contenus ocultés et emergents à travers l'acte de jouer, non seulement comme un instrument pour cet acte, mais également comme action thérapeutique pour la diminution de la tension, du stress et de la souffrance issus de l'hospitalisation. Enfin, l'art compose l'ensemble d'actions de soin dans le domaine de la santé

Triple artrodesis en el tratamiento de las deformidades podálicas en la edad pediátrica / Triple Arthrodesis in the treatment of podalic deformities in children

INTRODUCCIÓN: Las deformidades podálicas son muy frecuentes. La conducta que se ha de seguir ha sido siempre un tema complejo por las características individuales de cada deformidad. El propósito de este trabajo fue el estudio de la triple artrodesis del pie, su utilidad, sus indicaciones y sus complicaciones en el tratamiento de las deformidades podálicas en la edad pediátrica. MÉTODOS: Se realizó un estudio de intervención en el Complejo Científico Ortopédico Internacional Frank País de La Habana, Cuba, donde se evaluaron los pacientes pediátricos (10-18 años de edad) con deformidades podálicas que fueron tratados quirúrgicamente mediante una triple artrodesis en el período comprendido entre el 1 septiembre del 2008 y el 31 agosto del 2009. RESULTADOS: Prevaleció en el sexo masculino y entre los 13 a los 15 años de edad. El pie plano y el pie varo equino son las deformidades podálicas donde con mayor frecuencia se realizó la triple artrodesis del pie. La podoscopia, los estudios radiográficos y la aplicación de la escala visual analógica son importantes para evaluar con eficacia los resultados de la triple artrodesis. Con la utilización de las grapas se logró un alto índice de consolidación en las deformidades tratadas. La incidencia de complicaciones fue baja, la más frecuente encontrada fue el hematoma de la herida quirúrgica. En la mayoría de los pacientes (85,7 por ciento) ofreció buenos resultados. CONCLUSIONES: La triple artrodesis garantiza un bajo porcentaje de recidiva y una corrección factible de las desviaciones en varo o en valgo del pie

INTRODUCTION: Podalic deformities are very frequent. The behavior to be followed always has been a complex subject due to individual characteristics of each deformity. The aim of present paper was to study the foot triple arthrodesis, its usefulness, indications and complications in the treatment of podalic deformities in children. METHODS: A intervention study was conducted in the Frank País International Orthopedics Scientific Complex, Cuba to assess the pediatric patients (aged 10-18) with podalic deformities operated on by triple arthrodesis from September 1, 2008 to August, 31, 2009. RESULTS: There was prevalence of male sex aged between 13-15. The flat foot and equinovarus foot are the more frequent podalic deformities where a triple arthrodesis was carried out. The podoscopy, radiographic studies and application an analogous visual scale are important to assess efficaciously the results from triple arthrodesis. With the use of staples a high rate of consolidation of treated deformities was achieved. The incidence of complications was low and more frequent found was the hematoma of surgical wound. Most of patients (85,7 percent) had good results. CONCLUSIONS: The ripple arthrodesis guarantees a low percentage of relapse and a feasible correction of deviations in varus and valgus foot