BACKGROUND:Since November 2019, the SARS-CoV-2 pandemic has created challenges for preventing and managing COVID-19 in children and adolescents. Most research to develop new therapeutic interventions or to repurpose existing ones has been undertaken in adults, and although most cases of infection in pediatric populations are mild, there have been many cases of critical and fatal infection. Understanding the risk factors for severe illness and the evidence for safety, efficacy, and effectiveness of therapies for COVID-19 in children is necessary to optimize therapy. METHODS:A panel of experts in pediatric infectious diseases, pediatric infectious diseases pharmacology, and pediatric intensive care medicine from 21 geographically diverse North American institutions was re-convened. Through a series of teleconferences and web-based surveys and a systematic review with meta-analysis of data for risk factors, a guidance statement comprising a series of recommendations for risk stratification, treatment, and prevention of COVID-19 was developed and refined based on expert consensus. RESULTS:There are identifiable clinical characteristics that enable risk stratification for patients at risk for severe COVID-19. These risk factors can be used to guide the treatment of hospitalized and non-hospitalized children and adolescents with COVID-19 and to guide preventative therapy where options remain available.

Of 319 children with invasive candidiasis, 67 (21%) transitioned from intravenous to enteral antifungal therapy. Eight (12%) transitioned back to intravenous antifungal therapy, one due to perceived treatment failure defined by clinical progression or worsening. Global treatment response at study completion was successful in 66 participants who transitioned to enteral therapy.

Objective:To describe pubertal growth spurts among adolescents living with perinatally acquired HIV (ALWPHIV) on antiretroviral therapy (ART).Design:Observational data collected from 1994 to 2015 in the CIPHER global cohort collaboration.Methods:ALWPHIV who initiated ART age less than 10 years with at least four height measurements age at least 8 years were included. Super Imposition by Translation And Rotation (SITAR) models, with parameters representing timing and intensity of the growth spurt, were used to describe growth, separately by sex. Associations between region, ART regimen, age, height-for-age (HAZ), and BMI-for-age z-scores (BMIz) at ART initiation (baseline) and age 10 years, and SITAR parameters were explored.Results:Four thousand seven hundred and twenty-three ALWPHIV were included: 51% from East and Southern Africa (excluding Botswana and South Africa), 17% Botswana and South Africa, 6% West and Central Africa, 11% Europe and North America, 11% Asia-Pacific, and 4% Central, South America, and Caribbean. Growth spurts were later and least intense in sub-Saharan regions. In females, older baseline age and lower BMIz at baseline were associated with later and more intense growth spurts; lower HAZ was associated with later growth spurts. In males, older baseline age and lower HAZ were associated with later and less intense growth spurts; however, associations between baseline HAZ and timing varied by age. Lower HAZ and BMIz at 10 years were associated with later and less intense growth spurts in both sexes.Conclusion:ALWPHIV who started ART at older ages or already stunted were more likely to have delayed pubertal growth spurts. Longer-term follow-up is important to understand the impact of delayed growth.

Background. Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown. Methods. Candidemia episodes were included in a secondary analysis of a multicenter comparative effectiveness study that prospectively enrolled participants age 120 days to 17 years with invasive candidiasis (predominantly candidemia) from 2014 to 2017. Ophthalmologic examination (OE), abdominal imaging (AbdImg), echocardiogram, neuroimaging, and lumbar puncture (LP) were performed per clinician discretion. Adjunctive diagnostic studies performance and positive results were determined per episode, within 30 days from candidemia onset. Associations of aDS performance with episode characteristics were evaluated via mixed-effects logistic regression. Results. In 662 pediatric candidemia episodes, 490 (74%) underwent AbdImg, 450 (68%) OE, 426 (64%) echocardiogram, 160 (24%) neuroimaging, and 76 (11%) LP; performance of each aDS per episode varied across sites up to 16-fold. Longer durations of candidemia were associated with undergoing OE, AbdImg, and echocardiogram. Immunocompromised status (58% of episodes) was associated with undergoing AbdImg (adjusted odds ratio [aOR] 2.38; 95% confidence intervals [95% CI] 1.51-3.74). Intensive care at candidemia onset (30% of episodes) was associated with undergoing echocardiogram (aOR 2.42; 95% CI 1.51-3.88). Among evaluated episodes, positive OE was reported in 15 (3%), AbdImg in 30 (6%), echocardiogram in 14 (3%), neuroimaging in 9 (6%), and LP in 3 (4%). Conclusions. Our findings show heterogeneity in practice, with some clinicians performing aDS selectively, potentially influenced by clinical factors. The low frequency of positive results suggests that targeted application of aDS is warranted.

Objective: We investigated dynamics of inflammatory biomarkers in children with perinatally acquired HIV (PHIV) who started antiretrovirals at age less than 3 years and achieved sustained virologic control (HIV plasma RNA <400 copies/ml). Design: This was a retrospective analysis of inflammatory biomarkers in children enrolled in a randomized trial of early (<3 years of age) PI-based versus NNRTI-based regimens (P1060), who achieved sustained virologic control and participated in a neurodevelopmental follow-up study (P1104s) between ages 5 and 11 years. Methods: We measured 20 inflammatory biomarkers using ELISA or chemiluminescence at onset of sustained virologic control (Tc) and at P1104s entry (Te). Results: The 213 participants had median ages of 1.2, 1.9, and 7 years at antiretroviral initiation, Tc, and Te, respectively, with 138 on protease inhibitor-based and 74 on NNRTI-based regimens at Tc. Eighteen markers decreased and two increased from Tc to Te (Te-Tc). Biomarker subsets, particularly cytokines, the chemokine IP-10, and adhesion molecules sICAM-1 and sVCAM-1, correlated at Tc, Te, and Te-Tc. At Tc, higher biomarker levels were associated with younger age, female sex, HIV plasma RNA at least 750 000 copies/ml, lower nadir CD4 + %, lower nadir weight z scores, and NNRTI-based treatment. Greater Te-Tc biomarker declines were associated with younger age, male sex, higher Tc biomarker levels, lower nadir CD4 + %, and NNRTI-based treatment. Duration of controlled viremia and nadir height z scores showed mixed associations. Conclusion: Biomarker expression showed substantial coordination. Most markers decreased after virologic control. Demographic and clinical variables associated with biomarker patterns were identified. Mechanistic studies of these biomarker patterns are needed to inform interventions to control inflammation.

INTRODUCTION:Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS:Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS:A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS:Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.

Following hematopoietic stem cell transplant (HSCT), patients are at increased risk of vaccine-preventable diseases (VPDs) and experience worse outcomes of VPDs compared to immunocompetent patients. Therefore, patients are routinely vaccinated post-HSCT to restore VPD immunity. Published guidelines recommend revaccination based on time post-HSCT, although optimal revaccination timing and the value of using other clinical and laboratory variables to guide revaccination remain unclear. An institutional immune recovery-based protocol to guide timing of revaccination is used at Children's Hospital Colorado. This protocol incorporates time from transplant, time off immunosuppressive therapy and intravenous immunoglobulin replacement, absence of active graft-versus-host disease (GVHD), and minimum absolute CD4 count, absolute lymphocyte count (ALC), and immunoglobulin G (IgG) levels. The objective of this study is to evaluate the performance of this immune recovery-based revaccination protocol by determining rates of seroprotective vaccine responses achieved and describing demographic, clinical, and laboratory markers associated with protective antibody titers post-revaccination. Rates of seroprotection following revaccination were retrospectively determined for patients who received autologous or allogeneic HSCTs at Children's Hospital Colorado from 2007 to 2017. Percent seropositivity after revaccination was determined for ten VPDs: measles, mumps, rubella, varicella, tetanus, diphtheria, Haemophilus influenzae type B (Hib), poliovirus, hepatitis B virus (HBV), and Streptococcus pneumoniae. The impact of covariates, including post-HSCT vaccine timing, patient demographics, clinical features (diagnosis, donor and conditioning regimen data, GVHD, cytomegalovirus disease), and laboratory parameters (CD4 count, ALC, IgG level), on rates of seroprotection post-revaccination was determined using Wilcoxon rank sum, Fisher's exact, or chi-square tests, as appropriate. One hundred-twelve unique patients among 427 HSCT recipients had available data for both revaccination timing and vaccine titers. Among these, high rates of seroprotection were achieved after revaccination for rubella (100%), diphtheria (100%), tetanus (100%), and Hib (98%). More modest rates of seroprotection were achieved after revaccination with HBV (87%) and pneumococcal conjugate (85%) vaccines. Seroprotection was lower after revaccination with measles (76%), pneumococcal polysaccharide (72%), mumps (67%), and varicella (25%) vaccines. Greater rates of seroprotection were associated with younger age (hepatitis B vaccine, P = .04), lack of prior rituximab treatment (pneumococcal conjugate vaccine, P = .005), lack of total body irradiation (pneumococcal conjugate vaccine, P = .03), and receipt of a non-cord blood transplant (pneumococcal polysaccharide vaccine, P = .04). These results suggest that a revaccination protocol that incorporates both time post-HSCT and patient-specific indicators of immunologic recovery can achieve high rates of seroprotection against most VPDs. Seroprotection rates for HBV and PCV were notably among the highest reported in children post-HSCT, suggesting that an immune recovery-based protocol may improve seroprotection for some VPDs that frequently are associated with lower vaccine responses post-HSCT. Seroprotection rates for other VPDs remained suboptimal after revaccination. Therefore, evaluation of additional strategies, such as the use of novel markers of immune competence and new vaccines, to further optimize protection against VPDs in this population is warranted.

RESUMELa drepanocytose pose un probleme de sante publique au Mali. Elle concerne principalement les enfants et les adolescents. L’objectif de notre travail etait de decrire les profils epidemiologiques, cliniques et hematologiques de la drepanocytose dans une cohorte d’enfants suivis au service de pediatrie de l’hopital de Sikasso. Patient et Methodes. Il s’est agit d’une etude prospective transversale. Etaient inclus les enfants drepanocytaires confirmes a l’electrophorese de l’hemoglobine âges de 0 a 15 ans du 1er Janvier au 31 Decembre 2019. Resultats. Nous avons collige 72 dossiers de drepanocytaires (29 filles et 43 garcons). L’âge moyen etait 29,5mois. Il y avait une diversite ethnique avec une predominance de peulhs 36,1% suivi de senoufos 27,7% et les bambaras 18,1%. L’âge moyen des enfants a la premiere crise etait de 35,5mois. Les circonstances de decouverte etaient dominees par les douleurs abdominales 41,7% ; les douleurs osteo-articulaires 27,8% et le syndrome pieds-main 8,3%. Les signes cliniques a l’admission etaient predominer par La pâleur 62,5% ; l’ictere 29,1% et la splenomegalie 13,8%. Le type de complication qu’avait presente les enfants etait domine par la crise vaso-occlusives 56,2% suivi de l’infection 25% et de l’anemie aigue 12,5%. La forme homozygote SS etait dominante dans 57%. A l’hemogramme l'anemie etait retrouvee chez tous les enfants et elle etait normo chrome normocytaire dans plus de la moitie des cas (76,4%) et regenerative dans 69,4%. Conclusion : Le depistage neonatal de la drepanocytose pourrait ameliorer le diagnostic et favoriser une prise en charge precoce dans la region. ABSTRACTIntroduction. Sickle cell disease poses a public health problem in Mali. It mainly concerns children and adolescents. The objective of our work was to describe the epidemiological, clinical and hematological profiles of sickle cell disease in a cohort of children followed in the pediatric department of the Sikasso hospital. Patient and Methods. This is a cross-sectional prospective study. Included were children with sickle cell disease confirmed by hemoglobin electrophoresis aged 0 to 15 years from January 1 to December 31, 2019. Results. We collected 72 sickle cell disease files (29 girls and 43 boys). The average age was 29.5 months. There was significant ethnic diversity with a predominance of 36.1% Fulani followed by 27.7% Senoufos and 18.1% Bambaras. The average age of the children at the first attack was 35.5 months. The circumstances of discovery were dominated by abdominal pain 41.7%; osteoarticular pain 27.8% and hand-foot syndrome 8.3%. Clinical signs on admission were predominantly Pallor 62.5%; jaundice 29.1% and splenomegaly 13.8%. The type of complication presented by the children was dominated by vaso-occlusive crisis 56.2% followed by infection 25% and acute anemia 12.5%. The homozygous form SS was dominant in 57%. On the blood count, anemia was found in all children and it was normochromium, normocytic in more than half of the cases (76.4%) and regenerative in 69.4%. Conclusion. Newborn screening for sickle cell disease could improve diagnosis and promote early management in the region.

Objective: We examined relationships between plasma biomarkers and neurodevelopment in children from sub-Saharan Africa with perinatal HIV (PHIV) with controlled viremia on antiretroviral therapy (ART). Design: Longitudinal retrospective cohort study of children with controlled blood HIV replication. Methods: Children (N = 213; 57% girls) started ART at less than 3 years of age, had neurodevelopmental assessments (cognition, attention/impulsivity, motor proficiency, global executive functions) at 5–11 years, and achieved controlled viremia (HIV-1 RNA <400 copies/ml for ≥9 months before initial assessment). Twenty-three plasma biomarkers were measured at onset of controlled viremia, week 0 (first neurodevelopmental assessment), and week 48 (second neurodevelopmental assessment). Factor analysis was conducted at each time point. Multivariable linear regressions assessed associations between factors and neurodevelopmental scores. Results: Median age at week 0 was 7.0 years. Eighteen biomarkers loaded on six factors: a (L-10, IFNγ, IFNα2, IL-1β, IL-6, IP-10, TNFα); B (sCD163, sICAM-1, sVCAM-1, CRP); C (sE-selectin, sP-selectin); D [MIP-1β, vascular endothelial growth factor (VEGF)-A]; E (sCD14, CRP); and F (CX3CL1, MCP-1). Higher factor B scores were consistently associated with worse cognition and attention/impulsivity, and higher factor D scores with better attention/impulsivity. Conclusion: These results suggest a detrimental effect of increased endothelial cell activation (sICAM-1, sVCAM-1) and monocyte/macrophage scavenger function (sCD163) and a beneficial effect of increased CCR5 ligand and HIV entry blocker MIP-1β and angiogenesis stimulant-VEGF concentrations on the neurodevelopment of children with PHIV. The model that emerges is of vascular inflammation leading to neurodevelopmental deficits. The role of persistent HIV replication in the central nervous system also needs to be further explored.

BACKGROUNDInvasive candidiasis is the most common invasive fungal disease in children and adolescents, but there are limited pediatric-specific antifungal effectiveness data. We compared the effectiveness of echinocandins to triazoles or amphotericin B formulations (triazole/amphotericin B) as initial directed therapy for invasive candidiasis.METHODSThis multinational observational cohort study enrolled patients aged >120 days and <18 years with proven invasive candidiasis from January 1, 2014, to November 28, 2017, at 43 International Pediatric Fungal Network sites. Primary exposure was initial directed therapy administered at the time qualifying culture became positive for yeast. Exposure groups were categorized by receipt of an echinocandin vs receipt of triazole/amphotericin B. Primary outcome was global response at 14 days following invasive candidiasis onset, adjudicated by a centralized data review committee. Stratified Mantel-Haenszel analyses estimated risk difference between exposure groups.RESULTSSeven-hundred and fifty invasive candidiasis episodes were identified. After exclusions, 541 participants (235 in the echinocandin group and 306 in the triazole/amphotericin B group) remained. Crude failure rates at 14 days for echinocandin and triazole/amphotericin B groups were 9.8% (95% confidence intervals [CI]: 6.0% to 13.6%) and 13.1% (95% CI: 9.3% to 16.8%), respectively. The adjusted 14-day risk difference between echinocandin and triazole/amphotericin B groups was -7.1% points (95% CI: -13.1% to -2.4%), favoring echinocandins. The risk difference was -0.4% (95% CI: -7.5% to 6.7%) at 30 days.CONCLUSIONSIn children with invasive candidiasis, initial directed therapy with an echinocandin was associated with reduced failure rate at 14 days but not 30 days. These results may support echinocandins as initial directed therapy for invasive candidiasis in children and adolescents.CLINICAL TRIALS REGISTRATIONNCT01869829.

Background. In November 2020, the US Food and Drug Administration (FDA) provided Emergency Use Authorizations (EUA) for 2 novel virus-neutralizing monoclonal antibody therapies, bamlanivimab and REGN-COV2 (casirivimab plus imdevimab), for the treatment of mild to moderate coronavirus disease 2019 (COVID-19) in adolescents and adults in specified high-risk groups. This has challenged clinicians to determine the best approach to use of these products. Methods. A panel of experts in pediatric infectious diseases, pediatric infectious diseases pharmacy, pediatric intensive care medicine, and pediatric hematology from 29 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a guidance statement was developed and refined based on review of the best available evidence and expert opinion. Results. The course of COVID-19 in children and adolescents is typically mild and there is no high-quality evidence supporting any high-risk groups. There is no evidence for safety and efficacy of monoclonal antibody therapy for treatment of COVID-19 in children or adolescents, limited evidence of modest benefit in adults, and evidence for potential harm associated with infusion reactions or anaphylaxis. Conclusions. Based on evidence available as of December 20, 2020, the panel suggests against routine administration of monoclonal antibody therapy (bamlanivimab, or casirivimab and imdevimab), for treatment of COVID-19 in children or adolescents, including those designated by the FDA as at high risk of progression to hospitalization or severe disease. Clinicians and health systems choosing to use these agents on an individualized basis should consider risk factors supported by pediatric-specific evidence and ensure the implementation of a system for safe and timely administration that does not exacerbate existing healthcare disparities.

Amidst the coronavirus (COVID-19) pandemic, the American Society for Transplant Surgeons has recommended that only urgent liver transplant with deceased donors should occur. However, young pediatric candidates rely on living donors for lifesaving transplant. We present a case of non-directed left lateral lobe living liver donor transplant for a 7-month-old child with biliary atresia experiencing repeated life-threatening episodes of sepsis and cholangitis from infected bile lakes. Using careful preoperative planning among the entire multidisciplinary team, paying meticulous attention to infection control pre- and post-operatively, and taking advantage of robust telehealth technology both in and out of the hospital, a successful transplant was achieved. Amidst the COVID pandemic, non-directed liver transplantation can be safely achieved for pediatric recipients.

Background. Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Guidance is therefore needed regarding use of agents with potential activity against severe acute respiratory syndrome coronavirus 2 in pediatrics. Methods. A panel of pediatric infectious diseases physicians and pharmacists from 18 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a set of guidance statements was developed and refined based on review of best available evidence and expert opinion. Results. Given the typically mild course of pediatric COVID-19, supportive care alone is suggested for the overwhelming majority of cases. The panel suggests a decision-making framework for antiviral therapy that weighs risks and benefits based on disease severity as indicated by respiratory support needs, with consideration on a case-by-case basis of potential pediatric risk factors for disease progression. If an antiviral is used, the panel suggests remdesivir as the preferred agent. Hydroxychloroquine could be considered for patients who are not candidates for remdesivir or when remdesivir is not available. Antivirals should preferably be used as part of a clinical trial if available. Conclusions. Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For those rare cases of severe or critical disease, this guidance offers an approach for decision-making regarding antivirals, informed by available data. As evidence continues to evolve rapidly, the need for updates to the guidance is anticipated.

RESUME Introduction. la meningite est l'une des infections les plus graves observees chez les nourrissons et les enfants dans les pays tropicaux. L’objectif de notre travail etait de decrire les aspects epidemiologiques, cliniques, therapeutiques et evolutifs de la meningite chez les enfants de moins de 5 ans hospitalises dans le service de pediatrie generale du CHU Gabriel Toure de Bamako. Materiels et methodes. Il s’agit d’une etude transversale descriptive couvrant une periode de deux ans. Elle a inclus 120 enfants de moins de 5 ans atteints de meningite, parmi 3744 enfants hospitalises. Les echantillons de liquide cerebrospinal ont ete soumis a un examen direct, une coloration de Gram et une culture. Le test de Fisher de sante publique a ete utilise pour determiner les facteurs de risque de survenue des sequelles. Resultats. L’âge moyen des enfants etait de 3 ans et le sex-ratio de 1,3. La convulsion etait le principal motif de consultation (69%). Le delai moyen de consultation etait de 6 jours. Les principaux signes cliniques etaient la fievre (81%), l’hypotonie (51%) et les vomissements (44%). Les hemocultures realisees chez 81 patients ont isole le Streptococcus pneumoniae dans 57% des cas. Une bi-antibiotherapie etait la regle. La dexamethasone a ete utilisee dans 73% des cas. La duree moyenne du sejour hospitalier etait de 11 jours. Le sejour le plus long a ete observe chez les nourrissons. Des sequelles neurologiques ont ete observees dans 7% des cas. Le taux de letalite etait de 1 %. Conclusion. Nous constatons un retard dans le diagnostic de la meningite infectieuse chez l’enfant, responsable du long sejour hospitalier. Un diagnostic et un traitement precoces sont essentiels pour reduire les sequelles et la mortalite. ABSTRACT Introduction. Meningitis is one of the most serious infections in infants and children in tropical countries. The objective of our work was to describe the epidemiology, clinical presentation, management and outcome of meningitis in children aged 5 years or less in the general pediatrics department of the Gabriel Toure Teaching Hospital of Bamako. Methods. This was a two year cross sectional study including 120 children aged 5 years or less with clinically suspected meningitis, out of 3744 hospitalized children. The CSF samples were subjected to direct examination, Gram stain and culture. The public health Fisher test was used to determine the risk factors for the occurrence of sequels. Results. The mean age of children was 3 years and the sex-ratio was 1.3. Seizure was the main reason for consultation (69%). The average time delay before consultation was 6 days. The main clinical signs were fever (81%), hypotonia (51%) and vomiting (44%). Blood cultures from 81 patients isolated Streptococcus pneumoniae in 57% of cases. Bi-antibiotic therapy was the rule. Dexamethasone was used in 73% of cases. The average length of hospital stay was 11 days, the longest stay was observed in infants. Neurological sequels were seen in 7% of cases. The lethality rate was 1%. Conclusion. There is a long delay before the diagnosis of infectious meningitis, responsible for the prolonged hospital stay. Early diagnosis and treatment are essential to reduce sequels and mortality.

RESUME Introduction. La deshydratation induite par la diarrhee est une cause importante de mortalite dans les pays en developpement. Le but de notre travail etait de decrire les aspects epidemiologiques, cliniques, therapeutiques et evolutifs de la deshydratation aigue. Methodologie. Il s’agit d’une etude longitudinale prospective, descriptive ayant porte sur 59 cas de deshydratation aigue par diarrhee colliges dans le service de pediatrie generale, du 1er janvier au 31 juillet 2018. Nous avons inclus les enfants âges de 1 a 35 mois hospitalises pour deshydratation aigue consecutive a la diarrhee. Resultats. Nous avons inclus 59 enfants, avec un âge moyen de 9 mois et un sex-ratio de 0,88. Le delai moyen de consultation etait de 6 jours et 98% avaient recu un traitement avant leur admission. Les enfants recevaient une alimentation diversifiee dans 71% des cas et 27% etaient sous allaitement maternel exclusif. Un quart (25%) des patients n’etait pas completement vaccinee contre le rotavirus. Les selles etaient liquidiennes dans 86% des cas. La deshydratation etait moderee chez 24% des enfants et severe chez 76%. Le ringer lactate a ete administre chez 85 % des patients ; 63% des enfants ont recu une antibiotherapie. La duree moyenne d’hospitalisation etait de 8 jours. Le taux de letalite etait de 17%. Conclusion : des efforts supplementaires sont necessaires pour maitriser la mortalite infantile par diarrhee. ABSTRACT Introduction. Dehydration induced by diarrhea is an important cause of death in developing countries. The aim of our work was to describe the epidemiological, clinical and therapeutic and evolutionary aspects of acute dehydration. Methodology. This was a longitudinal prospective descriptive study in the general pediatric department of the CHU Gabriel Toure (Mali), from January 1 to June 31, 2018. We included children aged 1 to 35 months hospitalized for consecutive acute dehydration with diarrhea. Results. We included 59 children, with a mean age of 9 months and a sex ratio of 0.88. The mean time to consultation was 6 days and 98% had received treatment prior to admission. Children received a varied diet in 71% of cases and 27% were exclusively breastfeeding. A quarter (25%) of patients were not fully vaccinated against rotavirus. The stools were liquid in 86% of cases. Dehydration was moderate for 24% of children and severe for 76% of cildren. The lactate ringer was administered in 85% of patients; 63% of them received antibiotic therapy. The average length of hospital stay was 8 days. The case fatality rate was 17%. Conclusion. Tremendous efforts are still needed to control infant mortality from diarrhea.

RESUME Introduction. Au Mali des efforts ont ete entrepris dans la prevention contre les meningites bacteriennes par l’etat et les partenaires. Le but de notre travail etait d’evaluer la frequence et le profil bacterien des meningites en milieu hospitalier pediatrique apres l’introduction des vaccins. Materiels et Methodes. Nous avons examine les dossiers des enfants hospitalises âges de 1 mois a 15 ans dans le departement de pediatrie du CHU Gabriel Toure pour meningite bacterienne. Nous avons retenu comme meningite bacterienne tout cas dont la cytologie du LCR a objective au moins 10 leucocyte/mm3 avec ou non presence d’un germe a l’examen direct. Resultats. Nous avons etudie cent dossiers d’enfants hospitalises pour meningite bacterienne sur 9280 admission, soit une frequence de 1,07% .une proportion de 12% n’ont pas ete vaccines contre le pneumocoque et l’Haemophilus influenzae b. Les signes neurologiques ont ete les plus frequents (74,98%) a l’examen physique, domines par la raideur meningee (48 ,24%).Plus de la moitie de l’echantillon (66%) avaient recu une antibiotherapie avant l’admission. Les germes les plus frequents ont ete le pneumocoque (27%), l’Haemophilus influenzae b (9 %) et les salmonelles (2%).La letalite etait de 18%. le pneumocoque a ete le germe le plus letal avec 50% de cas (P=0,80). Conclusion. Malgre l’introduction du vaccin anti pneumococcique dans le programme elargi de vaccination du Mali, le pneumocoque demeure encore le germe le plus frequent et le plus letal ABSTRACT Introduction. In Mali efforts have been made to prevent bacterial meningitis by the State and Partners. The purpose of our work was to evaluate the frequency and bacterial profile of meningitis in a Pediatric Hospital after the introduction of vaccines. Materials and Methods. We reviewed the records of hospitalized children aged 1 month to 15 years in the Pediatric Department of Gabriel Toure Teaching Hospital for bacterial meningitis. We have selected as bacterial meningitis any case whose cytology of CSF showed at least 10 leucocytes/mm3 with or without the presence of a germ on direct examination. Results. We studied 100 cases of children hospitalized for bacterial meningitis on 9280 admissions, with a frequency of 1.07%. A proportion of 12% were not vaccinated against pneumococcus and Haemophilus influenzae b. The neurological signs were the most frequent (74.98%) on physical examination, dominated by cervical stiffness (48,24%). More than half of the sample (66%) had received antibiotic therapy before 'admission. The most common pathogens were Pneumococcus (27%), Haemophilus influenzae b (9%) and Salmonella (2%), and lethality was 18%. Pneumococcus was the most lethal germ with 50% of cases (P = 0.80). Conclusion. Despite the introduction of pneumococcal vaccine in Mali's Expanded Program on Immunization (EPI), Pneumococcus remains the most common and lethal germ.

Background In May, 2018, Children's Hospital Colorado noted an outbreak of enterovirus A71 (EV-A71) neurological disease. We aimed to characterise the clinical features of EV-A71 neurological disease during this outbreak. Methods In this retrospective observational cohort study, children (younger than 18 years) who presented to Children's Hospital Colorado (Aurora, CO, USA) between March 1 and November 30, 2018, with neurological disease (defined by non-mutually exclusive criteria, including meningitis, encephalitis, acute flaccid myelitis, and seizures) and enterovirus detected from any biological specimen were eligible for study inclusion. The clinical characteristics of children with neurological disease associated with EV-A71 were compared with those of children with neurological disease associated with other enteroviruses during the same period. To explore the differences in clinical presentation of acute flaccid myelitis, we also used a subgroup analysis to compare dinical findings in children with EV-A71-associated acute flaccid myelitis during the study period with these findings in those with enterovirus D68 (EV-D68)-associated acute flaccid myelitis at the same hospital between 2013 and 2018. Findings Between March 10 and Nov 10, 2018, 74 children presenting to Children's Hospital Colorado were found to have enterovirus neurological disease; EV-A71 was identified in 43 (58%) of these children. The median age of the children with EV-A71 neurological disease was 22.7 months (IQR 4.0-31.9), and most of these children were male (34 [7996] children). 40 (93%) children with EV-A71 neurological disease had findings suggestive of meningitis, 31 (72%) children showed evidence of encephalitis, and ten (23%) children met our case definition of acute flaccid myelitis. All children with EV-A71 disease had fever and 18 (42%) children had hand, foot, or mouth lesions at or before neurological onset. Children with EV-A71 disease were best differentiated from those with other enteroviruses (n=31) by the neurological findings of myoclonus, ataxia, weakness, and autonomic instability. Of the specimens collected from children with EV-A71, this enterovirus was detected in 94% of rectal, 79% of oropharyngeal, 56% of nasopharyngeal, and 20% of cerebrospinal fluid specimens. 39 (93%) of 42 children with EV-A71 neurological disease who could be followed up showed complete recovery by 1-2 months. Compared with children with EV-D68-associated acute flaccid myelitis, children with EV-A71-associated acute flaccid myelitis were younger, showed neurological onset earlier after prodromal symptom onset, had milder weakness, showed more rapid improvement, and were more likely to completely recover. Interpretation This outbreak of EV-A71 neurological disease, the largest reported in the Americas, was characterised by fever, myoclonus, ataxia, weakness, autonomic instability, and full recovery in most patients. Because EV-A71 epidemiology outside of Asia remains difficult to predict, identification of future outbreaks will be aided by prompt recognition of these distinct clinical findings, testing of non-sterile and sterile site specimens, and enhanced enterovirus surveillance. Copyright (C) 2019 Elsevier Ltd. All rights reserved.

RESUMEObjectif. Decrire les pratiques et les facteurs influencant l’allaitement maternel (AM) des nourrissons de 0 a 6 mois au CHU Gabriel Toure. Patient et Methodes. Il s’agit d’une etude transversale descriptive realisee sur une periode de 3 mois dans le departement de pediatrie. Elle concernait les nourrissons de 0 a 6 mois vus en consultation et leurs meres. Le test de khi2 a ete utilise pour la recherche de lien entre les variables et le seuil de signification p a ete fixe a 0,05. Resultats. La tranche d’âge des meres de 21 – 30 ans etait la plus representee (60%). La raison la plus frequemment evoquee par les meres pour la pratique l’allaitement maternel etait la protection contre les maladies (40%). Elles etaient informees par les sages-femmes dans 45, 22%. Trente-trois meres (28,70 %) ont affirme avoir mis leur nourrisson au sein aussitot apres l’accouchement. L’allaitement a la demande a ete pratiquee par 46 % des meres. Le choix personnel constituait la premiere source de motivation de l’AM (50%). Dans 10,43 % des cas les nourrissons ont recu l’allaitement maternel exclusif (AME). Le niveau d’instruction n’a pas eu d’influence sur l’AM. D’autrepart, ce sont plutot meres d’âge compris entre 21 et3 0 ans qui ont le plus pratique l’AME (difference statistiquement significative). Conclusion. La pratique de l’AME est faible dans nos structures. Elle est influence par plusieurs facteurs tels le niveau d’instruction, l’âge des meres et le lieu d’accouchement. ABSTRACTObjective. To describe the practices and the factors influencing the breastfeeding of children from 0 to 6 months at Gabriel Toure Teaching Hospital in Bamako. Subjects and Methods. This was a descriptive cross-sectional study carried out over a period of 3 months in the pediatric department. It concerned children from 0 to 6 months seen in consultation and their mothers. The chi2 test was used to search for a link between the variables and the significance level p was set at 0.05. Results. Mothers aged 21 - 30 were the most numerous (60%). The most common reason for practicing breastfeeding was protection against diseases (40%). Mothers were informed by midwives in 45.22% of cases. Thirty three mothers (28.70%) reported having breastfed immediately after giving birth. Breastfeeding on demand was practiced by 46% of mothers. Personal choice was the primary motivation for breastfeeding (50%). In 10.43% of cases, babies received exclusive breastfeeding. The level of education had no influence on the breastfeeding. Rather, mothers aged 21 to30 years have the most prone to practice exclusive breastfeeding (statistically significant difference). Conclusion. The practice of exclusive breastfeeding is low in our structures. Is is influenced by several factors such as educational level, maternal age and place of childbirth.