Background Diabetic ketoacidosis (DKA) is a potentially life-threatening metabolic disorder that can occur with the onset or during follow-up of type 1 diabetes (T1D). Once DKA has been resolved, discontinuing the intravenous insulin infusion may lead to a rebound of hyperglycemia. Therefore, this study aimed to demonstrate that early administration by an injection of long-acting insulin avoids a ketosis rebound after stopping intravenous insulin. Methods A retrospective study was conducted in the Femme-Mère-Enfant Hospital. We included patients aged 0 and 18 years, admitted to the intensive care unit and then to pediatric diabetology for DKA between January 2022 and April 2023. We separated patients into two groups depending on the protocol received. For the "old protocol" group, intravenous insulin was stopped when the acidosis was resolved, and before the patient was transferred, subcutaneous insulin injections were given in diabetology. For the "new protocol" group, subcutaneous injections of long-acting and rapid-acting insulin were administered before discontinuing the intravenous infusion in the intensive care unit before transfer. Results A total of 58 children were included. 46 patients were managed for inaugural DKA and 12 for DKA decompensating of known T1D. 41 patients received the old protocol, and 17 the new protocol. The incidence of ketosis rebound was lower in the "new protocol" group (41.2 % vs. 75.6 %; p 0.027). There is a significant association between the new protocol and reduced risk of ketosis rebound (OR 0.23, p 0.015). Multivariate analysis adjusted for potential confounding factors doesn't modify these results (OR 0.25, p 0.045). Conclusion Our study is the first pediatric study suggesting that earlier injection of long-acting insulin after resolution of DKA in children reduces the risk of ketosis rebound.

BackgroundWomen are more likely to develop heart failure (HF) after myocardial infarction. However, diagnosis and reperfusion are often delayed.ObjectivesTo compare the prevalence of HF after primary percutaneous coronary intervention (PPCI)-treated ST segment myocardial infarction (STEMI) between sexes and to study its associations with comorbidities, infarct size, and left ventricular (LV) systolic and diastolic dysfunctions (DD).MethodsThe patients with PPCI-treated anterior STEMI, from the CIRCUS study cohort, were followed up for 1 year and HF events were recorded. Evaluation of ejection fraction (LVEF) and DD were performed at baseline and at 1 year. The elevated LV filling pressure (LVFP) included Grades 2 and 3 DD.ResultsOf the 791 patients from the CIRCUS study, 135 were women. At 1 year, the proportion of patients who developed HF was 21% among men and 34% among women (p = 0.001). In the subset of 407 patients with available diastolic parameters, the rate of HF was also higher in women. HF during the initial hospitalization was comparable between the sexes. However, women had a higher incidence of rehospitalization for HF within the first year after STEMI (14.1% vs. 4.1%, p = 0.005). Women were older with a higher prevalence of hypertension. The infarct size and LVEF were similar between the sexes. Elevated LVFP was observed more frequently in women than in men during the initial hospitalization and at 1 year (26% vs. 12%, p = 0.04, and 22% vs. 12%, p = 0.006, respectively). Interestingly, only initial elevated LVFP (HR 5.9, 95% CI: 2.4–14.5, p < 0.001), age, and hypertension were independently associated with rehospitalization for HF.ConclusionsAfter PPCI-treated anterior STEMI, despite comparable infarct size and LVEF, women presented a higher proportion of rehospitalization for HF than men. That was likely due to a greater DD associated with older age and hypertension.

ObjectivesBronchopulmonary dysplasia (BPD) is the most common complication in preterm infants. This study aimed at identifying factors associated with early or with late or weaning failure from respiratory support or oxygen (O2) in preterm infants with BPD requiring respiratory support or O2 therapy after discharge from the neonatal intensive care unit (NICU).MethodsThis retrospective study was conducted in the NICU of a tertiary hospital, in infants born before 32 weeks of gestation between 2012 and 2021, and discharged from the NICU with a respiratory support (tracheostomy [TT], invasive ventilation [IV], Non-IV [NIV], continuous positive airway pressure [CPAP], high flow nasal canula [HFNC]) or O2 therapy for BPD. Univariate and multivariate analyses were performed to identify factors associated with early weaning (before 6 months postmenstrual age [PMA]) or late (after 6 months PMA) and weaning failure.ResultsAmong the 53 infants included (2% TT, 2% IV, 11% NIV, 25% CPAP or HFNC, 60% O2 at NICU discharge), 23 (43%) were weaned from respiratory support or O2 before 6 months PMA and 39 (73%) before 12 months PMA. IV duration during NICU stay and postnatal steroid treatment were identified as factors associated with a late or weaning failure (OR 1.03, p = .04 and OR 4.11, p = .023, respectively).ConclusionIn this study, nearly half of preterm infants with severe BPD were weaned from respiratory support or O2 before 6 months PMA. IV duration and postnatal steroid treatment during NICU stay were associated with a late or weaning failure.

Endocrine disruptors (ED) are ubiquitous pollutants, possibly implicated in chronic disease. Exposure of vulnerable populations; including neonates, infants and children; must therefore be limited. Informing parents is now a public health challenge. We conducted a quantitative cross-sectional study at the Lyon Mother and child Hospital. We used questionnaires to assess the beliefs and knowledge about ED of parents and pediatric healthcare professionals in the pediatric ward in Lyon, France. A total of 746 questionnaires were completed: 444 for professionals and 302 for parents. The majority of both populations had already heard of ED but only 10% of parents and 5% of professionals felt sufficiently informed. Professionals answered better than parents (73% vs. 60%). The main source of information was similar: media. Only 20% of professionals had read a scientific article about ED and 4% have followed a training. Environmental exposure and EDs is an increasing concern for parents but specific knowledge remains scare for parents and professionals. Specific training is needed.