Comportements des mères face à la position de couchage de leur bébé : effets de la dernière campagne de prévention concernant la mort subite du nourrissonMothers’ behaviors regarding infant sleeping position: effects of the last public education campaign for sudden infant death syndrome.

BACKGROUND: To define infant care practices in maternity units and those subsequently adopted at home. Using these data, we evaluated the acceptance and application of recommendations issued by the previous public education campaign on infant sleeping position as related to sudden infant death syndrome. PATIENTS AND METHODS: A survey was carried out in two maternity units (Port-Royal and Créteil) and in one pediatric consultation unit (affiliated with Port-Royal maternity). RESULTS: The mixed position (side or back) is used equally with, respectively, 47% at Port-Royal and 45% at Créteil. The supine sleeping position (French public health recommendations) is used by 12% of the mothers at Port-Royal and by 40% at Créteil. It appears that hospital nurseries play an important role in determining the mother's preference for the sleeping position (64% at Port-Royal and 54% at Créteil), but it does not adequately explain all mothers' responses. However, as the infants mature (> two months old), the more spontaneously they changed their sleeping position. All the infants placed in a side sleeping position moved to a supine sleeping position during the night. Upon awakening, infants were found mostly in the supine position (in contrast to the national public education campaign). CONCLUSION: Our results show that mothers and hospital nurseries were distressed in terms of ensuring the supine sleeping position of the infant. New choices of sleeping positions were initiated by mothers. For example, they used the side position after feedings essentially in the case of reflux or during the daytime. The supine position was used when the mothers were assured that any problems had been avoided or only during the night.     

Ostéomyélites aiguës de l’enfant drépanocytaire en zone tropicale : intérêt de l’utilisation des fluoroquinolones par voie oraleAcute osteomyelitis in children with sickle cell disease in a tropical country : benefit of the use of oral fluoroquinolones.

Aim. – This study was designed to assess the efficacy and the safety of fluoroquinolones in their compassionate use for acute osteomyelitis in children with sickle cell disease in a tropical country.Patients and methods. – This study was non comparative, including twelve children (eight SS, three SC and one SE°thalassemia) treated for acute osteomyelitis with oral ciprofloxacin or ofloxacin because of the following reasons : financial inability to afford conventional parenteral beta-lactams therapy (nine patients), refusal of hospitalization (two patients), and failure of conventional treatment (one patient).Results. – The mean age of patients was 9,5 ± 2,6 years. The long bones were the predominantly site. Salmonella species were present in 75 % of cases, followed by other enterobacteriaceae (16,7 %), and Staphylococcus aureus (8,3 %). Successful outcome occurred in all cases after three to four weeks of treatment and 45 days of plaster immobilization. Transient bilateral Achilles tendon tendinitis was noted in a five-year-old patient.Conclusion. – In economically developing countries, oral fluoroquinolones may be a therapeutic alternative for acute osteomyelitis in patients with sickle cell disease particularly in cases of financial hardship or failure with conventional therapy.     

Les premix : répercussions systémiques et buccodentaires

Alcopops are highly-sweetened premixed spirit-based drinks. Ready to drink and sold in small bottles, it contains between 3 and 5 % alcohol by volume, sugars, citric and malic acid with a pH around 3. Their success is attributed to the fact that spirits are more palatable and better tasting with a fruity flavour, similar to non alcoholic beverages. Especially aimed at female teenagers in search for the alcohol effect while disliking its strong taste, it has been sold in Europe for 15 years. So called “designer drinks” are often consumed during the weekend, binge-drinked with some friends. The frequent consumption has severe consequences on general health, which includes body overweight due to the amount of sugar, and alcohol-related consequences of utmost importance considering consumer's young age. Moreover, alcopops may introduce to the consumption of alcohol and induce addiction. Consequences on oral health may include dental erosion. Erosion is a premature loss of mineralized tissues (enamel and dentin), due to the contact with acids. The low pH of these drinks and the increased risk of vomiting because of an excessive alcohol intake could potentially lead to substantial damage to the teeth. The treatment depends on the erosion stage. The medical professionals should be aware of the possible implications relating to alcopops’ consumption. Some preventive advices can be given to the teenagers and to their parents: reduce acids consumptions, do not brush the teeth immediately after an acid drink and regularly visit a dentist.     

Évaluation de la réponse antipyrétique à 30 minutes de l'ibuprofène suspension aux urgences pédiatriquesAntipyretique activity of ibuprofen syrup in children emergency unit

The ibuprofen, a synthesis inhibitor of prostaglandin, has antipyretic effectiveness considerably studied and proved in the child.Objective. – The purpose of this study is to rate the precocious, total antipyretic effectiveness and in high fever (T ≥ 39.5 °C), of the pediatric population attending a children emergency unit. It is about a prospective study of 1120 feverish children collected between 1st August and 31st December 2001, at the Casablanca children emergency unit. The criteria of inclusion consisted of, the age between 6 months and 12 years old, a temperature ≥ 38 °C and the absence of previous use of antipyretics. The rectal temperature has been taken by a mercury thermometer. The posology used was about 10 mg/kg once. The rectal temperature has been controlled 30 min after the administration of the ibuprofen.Results. – The mean age was 40.8 months and the average of initial temperatures was 38.76 °C. The average of temperature decreased from 38.76 to 38.15 °C in 30 min (P < 0.05). In the group of children (n = 203) who suffered from high fever (T ≥ 39.5 °C), the average of temperatures went down from 39.83 to 38.93 °C in 30 min (P < 0.05). We did not notice any difference of effect concerning age.Conclusions. – This study confirms the effectiveness and the precocity of the antipyretic effect of the pediatric suspension ibuprofen in a children emergency unit.     

Chylothorax congénital et hypothyroïdie : à propos d’une observation

Congenital chylothorax, an uncommon disorder, is a therapeutic challenge without satisfactory results. When classical medical approaches fail (such as thoracosynthesis, total parenteral nutrition, and fasting followed by oral medium-chain triglycerides), some medical teams introduce somatostatin or octreotide in cases of recurring chylothorax. We report a case of recurring chylothorax treated with somatostatin at day 27 correlated with an unfortunate discovery of hypothyroidism on day 34. Clinical signs of chylothorax on somatostatin clearly improved with the introduction of levothyroxine. This article points out the relation between the two diseases based on a review of the literature.     

Clinique de la dyslexie

Dyslexia is characterized by a severe, persistent reading disorder occurring in an intelligent child. In the large field of learning disabilities, dyslexia is related to a cerebral dysfunction well described with Imagery and genetic studies. Nevertheless the diagnosis of dyslexia cannot be done by another way than clinical symptoms. Optimizing the management of children with dyslexia is a critical issue and is now possible, thanks to the improvement of neurosciences data and the mobilization of the key stakeholders. The knowledge of the precise symptoms is essential in order to lead the child's doctor able to improve coordination and harmonization of teaching and care and guidance of parents.