We report the sudden death of a 33-month-old child owing to acute respiratory distress syndrome due to human metapneumovirus (hMPV) infection. Of 30 children attending the same day care centre, 26% and 59% had hMPV and multiple infections, respectively; three of six children with pneumonia had a diagnosis of hMPV. hMPV infection is common in childhood viral co-infections but it can cause sudden death.

Background Respiratory syncytial virus (RSV) is the most frequently identified pathogen in children with acute lower respiratory tract infection. Fatal cases have mainly been reported during the first 6 months of life or in the presence of comorbidity. Case presentation A 47-month-old girl was admitted to the pediatric intensive care unit following sudden cardiopulmonary arrest occurring at home. The electrocardiogram showed cardiac asystole, which was refractory to prolonged resuscitation efforts. Postmortem analyses detected RSV by polymerase chain reaction in an abundant, exudative pericardial effusion. Histopathological examination was consistent with viral myoepicarditis, including an inflammatory process affecting cardiac nerves and ganglia. Molecular analysis of sudden unexplained death genes identified a heterozygous mutation in myosin light chain 2, which was also found in two other healthy members of the family. Additional expert interpretation of the cardiac histology confirmed the absence of arrhythmogenic right ventricular dysplasia or hypertrophic cardiomyopathy. Conclusions RSV-related sudden death in a normally developing child of this age is exceptional. This case highlights the risk of extrapulmonary manifestations associated with this infection, particularly arrhythmia induced by inflammatory phenomena affecting the cardiac autonomic nervous system. The role of the mutation in this context is uncertain, and it is therefore necessary to continue to assess how this pathogenic variant contributes to unexpected sudden death in childhood.

Screens are increasingly prevalent within families. The excessive use of screens by children has negative consequences. To measure the use of screens, we undertook an investigation among children being followed by pediatricians.An invitation to participate was sent electronically to 1460 private practice pediatricians. They were asked to complete the questionnaire on screen use by children under 12 years of age during a consultation, according to statements made by parents.One hundred and forty-four pediatricians submitted completed questionnaires involving 428 children. Among the 197 children under 3 years of age, 92 had played with an interactive screen for a median duration of 30 min during the preceding week; 29% of the children were alone at the time. One hundred and thirty-nine children had watched television for a median weekly duration of 75 min. Of the 231 children 3–11 years of age, 108 had played with an interactive screen for a median time of 30 min the day before the consultation, and 50% of them were alone at the time. One hundred and seventy-two children watched television for a median daily duration of 45 min. There was a correlation between these children's screen time and their mother's (r = 0.36). The television was on during meals and continuously in 35% and 21% of the families, respectively.Children start looking at screens early, too often watching unsuitable programs, and too often without a parent's present. Regardless of the child's age, pediatricians must ask parents how much time their children are viewing screens, advise them accordingly, and warn them of the consequences of excessive use.

La mort inattendue du nourrisson (MIN) est un problème notable de santé publique ayant fait l’objet de recommandations professionnelles en 2007. L’objectif principal est d’étudier les modalités de prise en charge des MIN à l’Institut médico-légal (IML) et au Centre de référence pour la mort inattendue du nourrisson (CRMIN) de Montpellier et de les comparer aux recommandations. Nous avons réalisé une étude rétrospective des MIN prises en charge au CHRU de Montpellier entre janvier 2011 et décembre 2013. Les modalités de prise en charge des deux services ont été comparées aux recommandations. Quarante-deux dossiers ont été inclus (âge médian = 9 semaines (0 ; 85) ; sex-ratio = 70 %). Le fond d’œil n’est jamais réalisé, l’imagerie cérébrale est pratiquée dans 47 % à l’IML et 81 % au CRMIN. À l’IML, les prélèvements infectieux sont deux fois moins effectués et les prélèvements bactériologiques, toxicologiques, et histologiques ne sont pas analysés dans trois quarts des cas. Une transmission du dossier a lieu dans 17 % des cas et une cause de décès est trouvée dans respectivement 47 % et 68 % des dossiers. L’imagerie cérébrale, les prélèvements infectieux, et l’analyse des prélèvements doivent devenir systématiques à l’IML. Une transmission du dossier au CRMIN est préconisée quand la cause du décès n’est pas identifiée au terme des investigations médico-légales. Une prise en charge optimale des MIN nécessite une meilleure prise en compte des recommandations actuelles. Une collaboration étroite entre l’IML et le CRMIN et une sensibilisation des magistrats sont indispensables. Sudden unexpected death in infancy (SUDI) is a significant public health problem, for which professional recommendations were published by the French National Authority for Health (HAS) in 2007. The main goal of this work was to study then compare with the HAS recommendations the ways the Forensic Institute (IML) and the Reference Center for SUDI (CRMIN) deal with SUDI at the University Hospital (CHRU) of Montpellier. We performed a retrospective study of SUDI cases the CHRU of Montpellier took charge of between January 2011 and December 2013. The ways both departments managed SUDI cases were compared item by item to the HAS recommendations. Forty-two medical records were included (median age: 9 weeks (0; 85); sex-ratio = 70%). A fundus ophthalmoscopy was never performed in either department, and brain imaging was performed in 47% of the cases at the IML and 81% at the CRMIN. Half as many infectious samples were performed at the IML compared to the CRMIN, and bacteriological, toxicological and histological samples were not analyzed in about 75% of the cases at the IML. Eight case records were transmitted from one department to the other, mainly from the CRMIN to the IML. The cause of death was found in 47% of the cases at the IML and in 68% at the CRMIN. Brain imaging, infectious sampling and the analysis of the performed samples should be systematic at the IML. When the cause of death is not identified after medico-legal investigations, we suggest the case records should be transmitted to the CRMIN. An optimal management of SUDI requires taking better consideration of the current recommendations, especially at the IML. A close cooperation between the IML and the CRMIN, and raising awareness among magistrates are necessary prerequisites.

Prise en charge et résultats à 1 an du traitement de la hernie congénitale du diaphragme (HCD) en France. Analyse du registre national français des HCD sur 157 cas de HCD enregistrés en 2011. Parmi les 157 cas le diagnostic était post-natal dans 27 cas et anténatal dans 130 cas. Le poids moyen de naissance était 2900 +/- 709g, le terme moyen de naissance était 36+/-5SA. La HCD était gauche dans 73% et droite dans 17%. Le plug anténatal était posé dans 13 cas. Le séjour médian en réanimation était de 24 jours (1-161), la mortalité était de 36/139 (26%). 9 patients ont eu une ECMO. L'âge médian au moment de la chirurgie était de 3.6 jours (0–32). La chirurgie a été réalisée par laparotomie dans 74 cas, coelioscopie dans 1, thoracotomie dans 4 et thoracoscopie dans 7 cas. Le défect diaphragmatique était fermé simplement dans 60 cas, un patch a été utilisé chez 28 patients (32%). Neuf valves antireflux et 6 gastrostomies ont étés réalisés au moment de la chirurgie première. Pendant la 1ere année 9 autres gestes antireflux et 8 gastrostomies ont été réalisés, 7 patients ont été opérés pour récidive, 5 pour occlusion sur bride. A 1 an le poids moyen était de 8.8 kg (23 percentile), 8 ont une nutrition entérale, 5 ont les troubles de l'oralité, 6 ont des complications neurologiques

Background: Significant reduction of necrotizing enterocolitis (NEC) and mortality rate has been recently reported in preterm infants supplemented with oral probiotics. Aim: To evaluate postnatal growth in preterm infants supplemented with different probiotic preparations and the occurence of late onset sepsis. Population and Methods: Prospective, randomized, double-blind, controlled study performed in 3 tertiary care neonatal units in France (Lyon, Montpellier). Preterm infants (26-31wks, 700-1600g) were randomly designed to receive daily supplementation with placebo (C) or probiotics (P) : bifidobacterium lactis (P1), bifidobacterium longum (P2) or both (P3) during 4-6 weeks. The number of subjects needed to show a 200g difference in body weight at the end of supplementation period, with a power of 90%, was 46 per group. Aerobic and anaerobic blood cultures were performed when a late onset sepsis was suspected. Results: 197 preterm infants (GA:29.1±14 wks, BW:1173±210g) were included: Placebo (n=52), Probiotics (n=142) from the first week of life (DOL=6.6±1.5d). At the end of the supplementation period, there was no difference in body weight (group C=1906±23g, group P=1875±14g, p=0.25) length and head circumference. The incidence of NEC was very low and similar between the 2 groups (NS). The incidence of late onset sepsis was similar between the 2 groups. None of these sepsis was related to a bifidobacteria. At term corrected age, there was no difference in anthropometric measurements and body composition analysis. Conclusion: Preterm infants supplemented with bifidobacteria did not exhibit a better postnatal growth. No adverse effect was related to probiotics.

Depuis deux décennies, la recherche expérimentale s’est efforcée de modéliser le stress périnatal et ses conséquences cliniques et biologiques. En laboratoire, l’effet du stress s’apparente à celui d’une programmation développementale et peut rendre compte de la survenue ultérieure de pathologies neuropsychologiques. Si un tel niveau de preuve n’est pas établi en clinique humaine, plusieurs observations suggèrent l’intervention modulatrice du stress périnatal dans le développement à court et long terme de l’enfant, ainsi qu’une vulnérabilité accrue aux troubles psychopathologiques. Après avoir rappelé les principaux modèles, cette revue présente quelques stratégies cliniques intégrant la gestion du stress dans l’objectif d’en limiter le retentissement.

The characteristics of sudden infant death syndrome (SIDS) in the French region of Languedoc-Roussillon from 2003-2008 were examined in a retrospective study of two groups classified as unexplained sudden unexpected death in infancy (SUDI) (SIDS, n=27) or explained SUDI (n=22). The interval between the time the baby was last observed alive (time of last feed) and the discovery of death was evaluated. In SIDS, 67% (18/27) of deaths were discovered during the day (09: 00-21:00 h) mostly within 4 h after feeding (66%). In explained SUDI, 68.2% of deaths were discovered at night and time intervals between the last feed and discovery of death were longer (mean 7.1 h, p<0.01). Most SIDS deaths were discovered during the day and explained SUDI discovered at night. Variations in time between the last feed and discovery of death in the two groups may result from differences in parental attentiveness during the day and at night.

Background: Intermittent infusion of vancomycin is widely used to treat late-onset sepsis in neonates. On the other hand, the continuous infusion of vancomycin could improve bactericidal efficacy since its action is time dependent.Objective: To evaluate a simplified dosage schedule for continuous-infusion vancomycin therapy.Methods: Prospective study in premature neonates (<34 weeks) with suspected coagulase-negative staphylococci (CoNS) sepsis. Before antibiotics at time zero (TO), serum creatinine was measured and blood cultures were collected. Vancomycin dosage began with 25 mg/kg/day or 15 mg/kg/day (period 1) and 30 mg/kg/day or 20 mg/kg/day (period 2) depending on whether serum creatinine was below or above 90 mu mol/l. Two days after beginning treatment (first timepoint: T1), serum vancomycin was measured and second blood cultures were collected.Results: Between June 2002 and December 2005, 145 neonates were evaluated. At birth, the median (inter-quartile range) body weight was 920 (500-1160) g and gestational age was 28 (26-29) weeks. At T1, serum vancomycin was within the required range in 74.5% of neonates (108/145). Serum vancomycin levels were higher in period 2 than in period 1 (20 mg/l vs 13 mg/l, p<0.05). At TO, 55% (80/145) of blood cultures were positive for CoNS, but 71% (57/80) were negative at T1. Four days after beginning treatment, 929% of subjects had recovered without removing the central venous catheter.Conclusion: Using this simplified dosage schedule, bactericidal efficacy was maintained and most Subjects had serum vancomycin concentrations within the therapeutic range.

Introduction All newborn acute pain scores require face observation. Using linen protecting from light aggressiveness as well as non-invasive ventilation masks make the face less accessible. The point is to validate FANS scale (Faceless Acute Pain Neonatal Scale) ignoring face survey. Methodology Prospective multi-centric study. We filmed premature babies (24–40 weeks of gestation) during a painful care (venipuncture). Three observers assessed pain with FANS and a validated score: DAN (Acute Pain of Neonate). The FANS based on movements, screaming and vegetative reactions survey. Reliability study included: inter-observers agreement and internal consistency (Cronbach alpha coefficient). Validity study included: intraclass correlation coefficient (ICC) between the 2 scales. To assess the discriminating ability towards painful and non-painful stimulation, 10 patients were observed (watched ? surveyed ?) during thigh rubbing and during puncture. FANS’score difference between the two situations were studied according to Wilcoxon test. Results From April 2006 to September 2007, 53 prematures 32 [30–35] weeks and 1500 [1000–2200] g. were observed (watched?). Cronbach alpha coefficient is 0.72. ICC were 0.92 [0.9–0.98] for inter-observer agreement and 0.88 [0.76–0.93] for scales correlation. The scores are significantly higher during the painful events/non painful stimulation: (3 [2–5] vs 1 [0–1], p Conclusion FANS scale seems reliable and valid. It is the very first scale to assess pain when face is inaccessible to survey.

Aim: There are still not enough informations to propose guidelines about post-discharge nutrition. We evaluated growth and bone mineralisation in very low birth weight (VLBW) infants fed preterm formula (PF) or standard term formula (TF).

Digitalis intoxication is usually accidental in children. We report the case of a young infant with congenital heart disease in whom the coadministration of digoxin and josamycin led to a 50% increase in the digoxin concentration, generating sinoatrial block and cardiac failure. Clinical and electrocardiographic symptoms very quickly resolved following immunotherapy with antidigitalis Fab fragments. Digoxin concentrations must be carefully monitored in patients concomitantly receiving macrolides to ensure that the digoxin dose can be readjusted if necessary. (c) 2006 Elsevier SAS. Tous droits reserves.