Objectives Neuroblastoma is the most common extracranial solid tumor in infants, with a possibility of spontaneous regression even in disseminated disease. Despite an overall good prognosis, relapse can worsen the outcome for some patients. A long-term analysis is crucial to identify subgroups of patients with poorer prognosis, assessing the risks of late relapse, progression or long-term toxicity associated with multimodal treatment in very young children.Methods Estimation of the 10-year event-free and overall survivals in 750 infants under 12 months with neuroblastoma, enrolled in the prospective INES protocols between 1999 and 2004. Follow-up data from INES patients were updated, and survival analyses were performed in order to determine prognostic factors such as age, stage, genomic profile, or MYCN amplification.Results Overall, 10-year overall survival was 91.1% +/- 1.0%, and 10-year event-free survival was 82.4% +/- 1.4%, with significantly better outcomes in infants under 6 months compared with those aged 6-12 months, even considering the MYCN-amplified tumors only. MYCN amplification was the strongest prognostic factor and was correlated with lower survival in patients with metastatic disease.Discussion Survival in patients less than 12 months remains excellent and stable even at long term, as a 10-year follow-up did not change the number of events. However, survival in MYCN-amplified tumors remained poor. Patients with metastatic tumors require accurate risk stratification. For each treatment group, there was no significant difference in long-term outcomes compared with previous publications from INES. No lethal toxicity affecting long-term survival occurred.

Abstract Background Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess compliance with antibiotic recommendations and factors associated with non-compliance. Methods We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme (ASP) organised once a week for the most part. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 h old, neonates < 37 weeks, age ≥ 18 years and children under surgical antimicrobial prophylaxis were excluded. Results 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% with no BI, 40.3% presumed (i.e., not documented) BI and 35.3% documented BI. Non-compliance with antibiotic recommendations occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%) and length of antibiotic therapy (18.0%). In multivariate analyses, the main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69–9.74, p = 0.0017), duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16–5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04–11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as “other” (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42–12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15–34.44, p = 0.0338) and ≥ 1 risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae (OR 2.56, 95%CI 1.07–6.14, p = 0.0353). Main independent factors for compliance were using antibiotic therapy protocols (OR 0.42, 95%CI 0.19–0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14–0.90, p = 0.0281) and aspiration pneumonia (OR 0.37, 95%CI 0.14–0.99, p = 0.0486). Conclusions Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a day-to-day basis the benefit of using several antimicrobials or any broad-spectrum antibiotics and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations. Trial Registration ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.

We recently proposed an equation to estimate the glomerular filtration rate (GFR) in children with cancer based on plasma cystatin C and serum creatinine levels together with body weight (the “CysPed equation”). The current clinical study reports a prospective evaluation of this equation in 18 children treated by nephrotoxic chemotherapy. The CysPed equation resulted in less bias and greater precision compared to two equations previously proposed equations by Schwartz, with or without plasma cystatin C. Moreover, the decrease in GFR due to chemotherapy was clearly identified by the CysPed equation. This equation may be used to monitor the renal function in childhood cancer units.

BackgroundThe success rate of non-operative treatment (NOT) of acute uncomplicated appendicitis (AUA) in children varies from 65% to 95%. There are no recommendations on the appropriate antibiotic therapy.ObjectiveTo determine the clinical efficacy of amoxicillin-clavulanic acid for NOT of AUA in children.MethodsDesign: Cross-sectional study in a single medical centre. Settings: Emergency department and Paediatric Visceral Surgery department of the Children Hospital in Toulouse, France. Patients: Patients 5–15 years old who were diagnosed with appendicitis, (1) With abdominal pain and a first episode of acute appendicitis, (2) With no radiological or ultrasound evidence of appendicolith, appendiceal perforation, pelvic abscess nor peritonitis, and (3) With non-septic general aspect, were included. Interventions: NOT consisted of hospital admission. The antibiotic treatment was a combination of amoxicillin and clavulanic acid (80 mg/kg/day of amoxicillin): intravenous regimen during 48 hours followed by oral route during 7 days. Main outcome measure: Success rate of amoxicillin-clavulanic acid NOT in children with AUA at 2 years.ResultsThe initial success rate of amoxicillin-clavulanic acid NOT in children with AUA was 100% (104/104 patients). The success rate at 2 years was 85.6% (89/104) at discharge. None of the 15 patients who underwent surgery after recurrence of appendicitis presented with peritonitis, appendiceal perforation nor pelvic abscess.ConclusionNarrowed antibiotic therapy with amoxicillin and clavulanic acid seems to be an alternative to surgery in children with AUA. It is necessary to wait for the results of ongoing studies to confirm these results.

Objective: To evaluate the outcomes of puberty in girls followed for Fetal Ovarian Cysts (FOC). Design: We included 83 girls of eight and more, followed at Toulouse Hospital for FOC. Historical data were collected through computerized medical record. Recent clinical, US and hormonal data were collected through a questionnaire filled up by the patients and their parents. Results: Of 83 eligible patients, 51 agreed to participate. Their median age was 11.6 years [8.6-17.6], 37 patients (72.5%) had pubertal signs, 18 patients had menarche (36%). The median age of puberty onset was 11 years 95% CI (10.5-11.5) and that of first menstruation was 13 years 95% CI (12.213.6). Fifty-two patients (96%) had no recurrence of ovarian cysts. No significant difference in the age of menarche, AMH levels, ovarian volume was noted. Regarding the 54 FOC including 3 bilateral cysts, 32 were simple (59.3%) and 22 (41%) were complex. The rate of cyst regression is 90% of cases in 2.1 months [0-8.9] for simple cysts and 54% of cases in 3.7 months [1.1-10.2] of complex cysts (rate p<0.0001 and time p=0.06). 23 small Cysts (diameter <40 mm) regressed in 90% of cases against 56% for the largest cysts (n=31) (p=0.01). The duration of regression of small cysts was 1.9 months, significantly less than that of largest cysts (median 3.4 months) punctured or not (p=0.05). Conclusion: The occurrence of FOC, whether liquid or complex, does not modify the pubertal profile, and no recurrence was observed.

The nature of the relationship between inherited abnormalities of the clotting system and the occurrence of cerebrovascular accidents in young subjects is controversial. To evaluate the risk of cerebrovascular disease associated with such abnormalities, we analyzed a series of 23 consecutive patients in a case-control study with ischemic stroke proven by computerised tomography and aged below 45 years at admission, and a control group of 115 age-and sex-matched controls from the general population. No differences in antithrombin, protein C, protein S, heparin cofactor II, plasminogen or response to activated protein C were observed between cases and controls. None of the patients had a history of personal or familial thrombosis, and none had a reduction in the considered clotting factor below the reference range. We conclude that abnormalities of the clotting system are not associated with the occurrence of cerebrovascular abnormalities in the young and that routine screening for inherited thrombophilia is not appropriate in young patients with cerebrovascular disease.

Photobiomodulation is recommended in adults for the prevention of mucositis induced by cervicofacial irradiation or pre-transplant chemotherapy. The results of pediatric studies are promising but this support treatment is still underused. The objective was to conduct a feasibility study in the pediatric hematology-oncology unit at X Children's Hospital. Extra- and intraoral scans were performed a minimum of three times every 2 days for grade 2 or higher mucositis in children (median age, 8.6 years) using the Oncolase laser (Biophoton, Saint Alban, France), with a combination of two wavelengths (635 and 815nm). The effect of the laser on mucositis grade, pain, the child's tolerance, and the time dedicated to this care were also evaluated. The success of the procedure was 77% in 1 year, with the inclusion of 84% of the patients (n=22) and 146 laser treatment sessions (median of four per episode of mucositis). We observed excellent tolerance and pain relief with a gain of two points on the VAS and the HEDEN mucositis scale. This study shows that photobiomodulation that incorporates two application modes (intra- and extraoral) through the combination of two wavelengths is feasible when integrated into the care of a pediatric hematology-oncology department and is perfectly tolerated, even by young children. Along with oral hygiene and analgesic management, it alleviates pain associated with oral mucositis.

Neuroblastoma (NB) is the most common extra-cranial tumour in children. Little is known about the aetiology of NB. The early age at onset and the embryonic nature suggest a role for perinatal exposures. We conducted a pooled analysis of two French national population-based case-control studies to explore whether there was an association between parental smoking and alcohol consumption and the risk of NB. The mothers of 357 NB cases and 1,783 controls from general population, frequency matched by age and sex, were interviewed on demographic, socioeconomic and perinatal characteristics, maternal reproductive story, and life-style and childhood environment. Unconditional logistic regression was used to estimate pooled odds ratios and 95% confidence intervals. A meta-analysis of our findings with those of previous studies was also conducted. Maternal smoking during pregnancy was slightly more often reported for the cases (24.1%) than for the controls (19.7%) (OR 1.3 [95% CI 0.9-1.7]; summary OR from meta-analysis 1.1 [95% CI 1.0-1.3]. Paternal smoking in the year before child's birth were not associated with NB as independent exposure (OR 1.1 [95% CI 0.9-1.4] but the association was stronger when both parents reported having smoked during pregnancy (OR 1.5 [95% CI 1.1-2.1]. No association was observed with maternal alcohol intake during pregnancy (OR 1.0 [95% CI 0.8-1.4], summary OR from meta-analysis 1.0 [95% CI 0.9-1.2]. Our findings provide some evidence of an association between maternal smoking during pregnancy and NB and add another reason to recommend that women refrain from smoking during pregnancy.

Background: Anterior cruciate ligament (ACL) injuries are common in adults and cause knee instability, pain, and an increased risk of osteoarthritis. Previous studies demonstrated changed gait patterns in adult patients with ACL deficiency. In paediatric patients, ACL injuries were once thought to be rare but are being increasingly diagnosed due to greater involvement of children in contact sports and to the introduction of more effective diagnostic tools such as magnetic resonance imaging (MRI). However, little is known about gait adaptation in children with ACL deficiency. The objective of this study was to look for compensatory foot and ankle behaviours during gait in paediatric patients with symptomatic ACL deficiency. Hypothesis: Compensation for ACL deficiency during gait occurs at the foot and ankle in children, because compensation at the hip and pelvis would require greater energy expenditure. Material and methods: We included 47 patients, 33 males and 14 females, ranging in age from 9 to 17 years (mean, 14.1 years). The patients had a history of unilateral ACL injury documented by MRI and initially treated by immobilisation and physical therapy. They were allowed to walk with full weight-bearing on the affected limb and were not taking medications at the time of the study. All patients had pain, knee instability, or functional limitation. The physical examination showed joint laxity indicating surgical ACL reconstruction. None had neurological conditions, congenital musculoskeletal abnormalities, or a history of knee surgery. Gait analysis (GA) was performed using a Vicon 460 system. Kinematic data for the ankle and foot were compared to those in a control group of 37 healthy children. Ankle angular positions were calculated for each group at the following stance time points: initial contact (0% of gait cycle [GC]), mid stance (25% GC), terminal stance (60% GC), and swing (83% GC). Foot progression data were recorded at mid-stance (25% GC) and swing (70% GC). Student's t test was applied to compare the results to reference values obtained at our laboratory and to data from the control group. Results: Compared to the reference values, the ankle was in plantar flexion at initial contact in 41 patients, and ankle dorsiflexion during the stance phase was diminished in 39 patients. The external foot progression angle was increased in 23 patients during the stance phase and 38 patients during the swing phase. Compared to the control group (mean age, 9.1 years), the patients had plantar flexion of the ankle at initial contact (3.43 degrees +/- 3.5 degrees vs. 0.74 degrees +/- 3.6 degrees, p < 0.05) and decreased dorsiflexion during the stance phase (3.43 degrees +/- 3.5 degrees vs. 0.74 degrees +/- 3.6 degrees, p < 0.05). No significant differences were found for any of the other parameters. Discussion: Children with ACL deficiency developed compensatory foot and ankle behaviours during gait that improved knee stability. Understanding these compensations may guide treatment optimisation. (C) 2019 Elsevier Masson SAS. All rights reserved.

Background: Most of osteosarcomas (OS) originate on the medullary canal, and only a small proportion arises from the surface of bone. Surface OS can be divided into three distinct histologic subtypes: parosteal OS, periosteal OS and high-grade surface OS. This national retrospective study was conducted to review the treatment and clinical outcome of children surface’ OS in order to upgrade and homogenize practices. Methods: Data of 28 pediatric patients with surface OS treated in 11 French Cancer Centers (SFCE) between 1990 and 2010 were reviewed. Results: Eleven patients had parosteal, sixteen patients had periosteal and one patient had high-grade surface OS. The median age at the diagnosis was 14.3 years (range, 5.8 –17.9 years). Seven patients were male. None had metastatic disease at diagnosis. All 28 patients were treated with surgery, of whom 21 (7 parosteal, 13 periosteal and 1 high-grade tumors) received chemotherapy (adjuvant or neo-adjuvant). Three patients relapsed (local relapse for 1 patient with parosteal OS and distant relapses for two patients with periosteal OS) and four patients with periosteal OS developed a second cancer (three out of four died). The 11-year overall survival rate was 100% for parosteal OS and 63 ± 18% for periosteal OS. Conclusion: The histologic grade determines the clinical behavior and prognosis in pediatric surface OS. Complete resection is the treatment of choice regardless of pathology. Regarding prognosis, our study argues for the use of adjuvant chemotherapy in periosteal OS, as well as for oncogenetic counseling.

The aim of this study was to review and describe therapeutic approaches in children with choroid plexus tumor (CPT) based on a nationwide series. The World Health Organization classification subdivides these rare tumors into three histological subtypes corresponding to three grades of malignancy: low grade (grade I) choroid plexus papilloma (CPP), intermediate grade (grade II) atypical choroid plexus papilloma (aCPP) and high grade (grade III) choroid plexus carcinoma (CPC). This retrospective study included 102 French children younger than 18 years, treated from 2000 to 2012: 54 CPP, 26 aCPP and 22 CPC. The 5 year overall survival was 100% in CPP, 96.2% in aCPP and 64.7% in CPC. In patients with localized disease, complete surgical resection was achieved in 48/52 CPP, 20/26 aCPP and 7/14 CPC. In this group, patients with complete surgical resection had better event free survival than patients with partial resection (88.9 vs. 41.6%). 28 patients (1 CPP, 6 aCPP and 22 CPC) had adjuvant chemotherapy. 2 aCPP and 9 CPC had radiotherapy. We underlined the need for a central histological review to accurately analyze clinical data; we reported a much higher overall survival for CPC than in most previous CPT series probably including atypical teratoid rhabdoid tumors. In our series, the 5 years overall survival in CPC (64.7%) was higher than event free survival (25.2%) and could be interpreted as a clue for the efficiency of adjuvant/salvage therapy even if the heterogeneity of applied treatments in this retrospective series does not allow for meaningful statistical comparisons.

Le syndrome douloureux régional complexe de type I (SDCR I) chez l’enfant diffère de celui chez l’adulte et la littérature le concernant est peu abondante. Notre objectif était de rechercher les facteurs de risque potentiels et d’évaluer la qualité de vie à moyen terme. Les données médicales des patients ayant présenté un SDCR I entre 2004 et 2012 ont été collectées. Les patients et leurs parents ont été contactés par téléphone afin de leur soumettre le questionnaire de qualité de vie PEDS QL 4-0. Les résultats ont été ensuite comparés à un groupe témoin comparable pour l’âge, le sexe et le niveau socioéconomique. Soixante-treize patients ont été inclus (64 filles, 9 garçons). L’âge moyen au diagnostic était de 11,5 ans avec un retard de diagnostic moyen de 14,2 mois. Le membre inférieur était atteint 65 fois (89 % des cas). Une allodynie, une froideur et une cyanose étaient notées respectivement dans 95 %, 81 % et 74 % des cas. Trente-six patients (49 %) ont rapporté un traumatisme physique. L’analyse multivariée a montré une forte association avec le fait d’être anxieux : OR = 44,9, 95 % IC (7,4–273), de présenter un terrain atopique : OR = 25,0, 95 % IC (4,6–135), d’être un bon ou excellent élève OR = 8,4, 95 % IC (1,3–52,1) et d’avoir des difficultés d’endormissement : OR = 5,3, 95 % IC (1,6–17,0). Au recul moyen de 37 mois (10–102), le score PEDS QL 4-0 était significativement inférieur chez les patients avec un SDCR I comparativement au groupe témoin. Cinquante-sept pour cent des patients déclaraient être guéris et 55 % avaient présenté une récidive. Le SDCR I touche principalement les chevilles chez les filles préadolescentes. L’évolution est moins favorable que ce que l’on pense d’un point de vue physique et émotionnel. Le facteur psychologique est important. IV.

La rupture du ligament croisé antérieur (LCA) représente une pathologie fréquente dans la population adulte, qui a comme conséquence l’instabilité et le risque de dégénérescence prématurée du genou. Plusieurs études ont montré des modifications de la marche chez l’adulte. Considérée longtemps une pathologie rare chez l’enfant, l’incidence de la rupture du LCA augmente progressivement, car les enfants sont plus impliquées dans des activités sportives et des examens spécifiques (IRM) sont plus disponibles, facilitant le diagnostic. L’objectif de notre étude était d’évaluer les modifications de la marche des enfants avec une lésion du LCA, et surtout les adaptations de la cheville et du pied à l’instabilité du genou. Nous avons étudié 47 patients (14 filles, 33 garçons) âgés de 9 à 17 ans (âge moyen 14,1) avec une lésion unilatérale du LCA, confirmée par IRM et traitée initialement par immobilisation et rééducation. Tous les patients étaient symptomatiques, avec sensation d’instabilité du genou. Chaque patient a réalisé une analyse quantifiée de la marche (AQM) et nous avons analysé la cinématique de la cheville (en appui et en phase oscillante) et la progression plantaire. Les données des patients ont été comparées à la référence de notre laboratoire et aussi aux valeurs d’un groupe de 37 enfants sains (analyse statistique test-t). Par rapport à la référence du laboratoire - la cheville était en flexion plantaire(FP) à l’attaque du pas pour 41 patients. La flexion dorsale(FD) du pied était diminuée pour 39 patients en phase d’appui. La progression plantaire en rotation externe augmentée a été notée pour 23 patients en phase d’appui et pour 38 patients en phase oscillante. Par rapport au groupe des patients sains - les enfants avec lésion du LCA marchent avec FP à l’attaque du pas (3,43° ± 3,5 vs 0,74° ± 3,6, p < 0,05) et FD diminuée en phase d’appui (3,43° ± 3,5 vs 0,74° + 3,6, p < 0,05). Pour le reste des paramètres il n’y avait pas de différence significative. Les enfants présentant une instabilité antérieure du genou ont des compensations au niveau de la cheville et du pied qui permettent une meilleure stabilisation du genou. La compréhension de ces adaptations pourrait être utile dans le traitement de cette pathologie.

Background Sickle cell disease ( SCD ) is an inherited disorder characterized by recurrent painful crises with ischemia resulting from vascular occlusion. Adults with SCD have increased arterial stiffness and reduced flow‐mediated dilation ( FMD ), due to impaired release of substances such as nitric oxide. Aim We aimed to assess the vascular properties of carotid and brachial arteries in children with SCD compared with a control group without cardiovascular risk factors. Methods Thirty patients with SCD , mean age 12.3 ± 4.5 years, were prospectively enrolled. A control group was made up of 30 age‐ and gender‐matched healthy subjects. Carotid intima–media thickness ( IMT ), cross‐sectional compliance ( CSC ), cross‐sectional distensibility ( CSD ), diastolic wall stress ( DWS ), incremental elastic modulus (Einc), and FMD were determined in both groups. Results There was no significant difference in FMD between the two groups (8.2 ± 5.0% in the SCD group vs. 9.3 ± 4.2% in the control group, P = 0.15). There was no significant correlation between FMD and age, hemoglobin, LDH level, or transcranial Doppler findings. CSD was significantly elevated in the SCD group (0.96 ± 0.44 vs. 0.59 ± 0.21, P = 0.0002), whereas DWS and Einc were significantly lower in the SCD group. CSC did not differ significantly between the two groups. Conclusions Children with SCD have no marked endothelial dysfunction or change in arterial stiffness. These manifestations may be related to disease severity and duration. Changes may become evident later in life as the disease progresses.

Neuroblastoma (NB) is the most frequent indication for extracranial pediatric radiotherapy. As long-term survival of high-risk localized NB has greatly improved, we reviewed treatment-related late toxicities in pediatric patients who received postoperative radiotherapy (RT) for localized NB within two French prospective clinical trials: NB90 and NB94.

Introduction: Complex regional pain syndrome type 1 (CRPS I) in children differs from its adult counterpart and relevant literature is scarce. Our aim was to investigate potential risk factors and to assess midterm outcome and quality of life.Material and methods: Medical records of patients diagnosed with CRPS I between 2004 and 2012 were analyzed. Patients and parents were called for a phone interview including the PEDS Quality of Life 4-0 questionnaire. Results were compared to a control group matched for age, gender and socio-economic status.Results: Seventy-three patients were included (64 girls, 9 boys). Mean age at diagnosis was 11.5 years and mean time to diagnosis was 14.2 months. The lower limb was affected in 89% of cases. Allodynia, coldness and cyanosis were noted in 95%, 81% and of 74% of cases, respectively. Forty-nine percent of patients reported a physical injury. Multivariate analysis showed a strong association with being anxious (OR = 44.9, 95% CI [7.4-273]), presence of an atopic background (OR = 25.0, 95% CI: [4.6-135]), being good to excellent school performers (OR = 8.4 95% CI [1.3-52.1]), and having trouble falling asleep (OR = 5.3,95% CI [1.6-17.0]). At a mean 37 months' follow-up (12-102), PEDS QL 4-0 score was significantly lower in CRPS patients compared to controls. Fifty-seven percent of patients acknowledged healing and 55% had presented a relapse.Conclusion: Childhood onset CRPS I affects predominantly preadolescent girls at the ankle. The present study highlights the relatively poor outcome, especially its physical and emotional aspects and the large role of psychology. (C) 2015 Elsevier Masson SAS. All rights reserved.

L’objectif principal était d’évaluer nos pratiques pour valider notre stratégie thérapeutique. L’objectif secondaire était d’analyser la faisabilité d’une désescalade thérapeutique dans un groupe «très bas risque». Etude rétrospective, multicentrique reprenant la prise en charge et le devenir des épisodes de neutropénie fébrile (NF) chez des enfants admis au sein du Réseau Oncomip entre 2002 et 2012. Nous avons eu 293 épisodes de NF qui ont concerné 138 enfants. L’âge médian au diagnostic était 7,2 ans (1mois-17ans). La pathologie sous-jacente la plus fréquente était une leucémie aiguë lymphoblastique (37,5%). Parmi les 138 patients, 71(51,4 %) ont été classé dans le groupe «Bas Risque» et 67(48,6 %) «Haut Risque». Un événement (hémoculture positive) a eu lieu dans 10% des cas (différence non significative entre les 2 groupes) mais aucun événement grave n’a été enregistré. Les procédures ont été suivies dans plus de 75% des cas. Une escalade thérapeutique a été notée dans 4,4% des cas. Nos procédures locales avec relais monodose sont efficaces et sûres. Une évaluation des niveaux de risque pourrait permettre la reconnaissance d’un groupe d’enfants «très bas risque» pour lequel une antibiothérapie orale pourrait être initiée d’emblée