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Documents  Pédiatrie | enregistrements trouvés : 74

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Cough Conundrums; A Guide to Chronic Cough in the Pediatric Patient | Décembre 2022 H

Article (Pédiatrie, néonatologie et périnatalité)

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Practice Gaps
Cough is a common presenting chief complaint in the pediatric population. Characteristics of cough that are revealed in either the history or physical examination can facilitate diagnosis and management.

Objectives
After completing this article, readers should be able to:

Manage the common causes of cough, recognizing the underlying mechanics of coughing.

Discuss effective and efficient management options based on gathered clinical evidence.

Review existing guidelines for the management of chronic cough.

Identify when subspecialty referral is appropriate.

Clinical Case
A 12-year-old boy with autism spectrum disorder presents with concerns of progressively worsening wet-sounding cough for 3 weeks that is worse at night and clears throughout the day. He was initially evaluated 2 weeks earlier and given albuterol for possible reactive airway disease. He denies fevers, exercise limitation, or viral prodrome. On examination he is afebrile, with a respiratory rate of 18 breaths/min, heart rate of 100 beats/min, blood pressure of 100/67 mm Hg, and pulse oxygen saturation of 100% on room air. He appears comfortable. Physical examination is remarkable for bilateral upper lobe faint expiratory wheezing and right-sided neck swelling. What is the next step in the management of this patient?
Practice Gaps
Cough is a common presenting chief complaint in the pediatric population. Characteristics of cough that are revealed in either the history or physical examination can facilitate diagnosis and management.

Objectives
After completing this article, readers should be able to:

Manage the common causes of cough, recognizing the underlying mechanics of coughing.

Discuss effective and efficient management options based on gathered ...

Appareil respiratoire - Maladies ; Maladies chroniques ; Pédiatrie

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Ultrasound to Verify Gastric Tube Position in Infants and Children: A Systematic Review | Décembre 2022 H

Article (Pédiatrie, néonatologie et périnatalité)

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Background: Placement of gastric tubes is commonly performed in infants and children but malpositioning is common and is associated with significant complications.

Objective: The aim of this systematic review is to identify the evidence on the use of ultrasound to verify correct gastric tube placement in infants and children and gaps in the research.

Methods: This review was performed using CINAHL, PUBMED, EMBASE and Web of Science databases. Studies were included if they used an empirical study design, were published in English, included infants or children, and evaluated the use of ultrasound to verify correct gastric tube placement compared to radiograph. Sensitivity, specificity, positive and negative predictive values were evaluated.

Results: Four articles were included in the review. Sensitivity estimates were 0.88 to 1.00 and a positive predictive value of 0.99 was reported in one study. Specificity was not reported in any of the included studies. Ultrasound may be an important method to correctly identify gastric tube placement in infants and children with less radiation exposure and cost.

Implications for Practice: Ultrasound could be a used to verify gastric tube positioning in infants and children for both initial placement and continued verification leading to reduced radiation exposure and cost.

Implications for Research: Research should focus on evaluating ultrasound specificity and the clinical feasibility of using ultrasound as a standard practice, including cost and time required to complete the exam, as well as the ability of ultrasound to verify gastric tube placement in infants weighing less than 1500 grams.
Background: Placement of gastric tubes is commonly performed in infants and children but malpositioning is common and is associated with significant complications.

Objective: The aim of this systematic review is to identify the evidence on the use of ultrasound to verify correct gastric tube placement in infants and children and gaps in the research.

Methods: This review was performed using CINAHL, PUBMED, EMBASE and Web of Science databases. ...

Pédiatrie ; Radiographie (Médecine) ; Ultrasons en médecine

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Evaluation and management of paediatric vertigo | Décembre 2022 H

Article (ORL)

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Purpose of review: This review summarizes the most current information on cause, evaluation and treatment of dizziness in children.

Recent findings: There has been an increased understanding of the multifactorial cause of dizziness in the paediatric population. Quantitative vestibular testing is increasingly used and valuable as a diagnostic adjunct. Vestibular rehabilitation, migraine hygiene, psychological therapies, pharmaceuticals and/or surgery can be used as well tolerated and effective treatments for vertigo in children and adolescents when tailored to cause.

Summary: Paediatric vertigo can be effectively evaluated through careful history taking and physical examination along with adjunctive tests, such as vestibular testing and audiometry, when appropriate. Options for treatment of vestibular disorders in children and adolescents have greatly expanded in recent years allowing for the effective management of nearly all cases of paediatric vertigo, though a multimodal and/or multidisciplinary approach is often needed.
Purpose of review: This review summarizes the most current information on cause, evaluation and treatment of dizziness in children.

Recent findings: There has been an increased understanding of the multifactorial cause of dizziness in the paediatric population. Quantitative vestibular testing is increasingly used and valuable as a diagnostic adjunct. Vestibular rehabilitation, migraine hygiene, psychological therapies, pharmaceuticals and/or ...

Vertige ; Pédiatrie ; Vertige chez l'enfant

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Purpose of review: Cardiovascular damage could begin early in life. Our aim was to examine the current state of the art related to micronutrient supplementation on vascular health in obese and overweight children. We considered only the studies performed over the past few years.

Recent findings: Vitamin D supplementation in the obese pediatric population with vitamin D deficiency could improve the vascular health of these subjects. The evidence is less clear on supplementation with other micronutrients. Zinc supplementation is currently the most supported by the literature.

Summary: As of today, we can only speculate that supplementation with other micronutrients could improve the vascular health of obese and overweight children. Strong limitations are the different instrumental methods used to assess vascular health in obese children and adolescents under micronutrients supplementation. Actually, indirect indicators more reliable to evaluate vascular health seem to be lipid profile and insulin sensitivity. Furthermore, there is a particular lack of studies in this area in recent years, especially in the pediatric population. Additional studies performed in this population should be pursued to clarify significant relationships between micronutrients and vascular health.
Purpose of review: Cardiovascular damage could begin early in life. Our aim was to examine the current state of the art related to micronutrient supplementation on vascular health in obese and overweight children. We considered only the studies performed over the past few years.

Recent findings: Vitamin D supplementation in the obese pediatric population with vitamin D deficiency could improve the vascular health of these subjects. The evidence ...

Obésité ; Pédiatrie ; Enfants - Santé et hygiène

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Background: Patients with pediatric leukemia and sickle cell disease are at risk for developing osteonecrosis (ON), a disease that can result in pain, loss of function, and disability. Hip core decompression surgery is an option aimed to prevent femoral head collapse and avoid future arthroplasty.

Objective: Describe functional outcomes and gait quality among a young population with hip ON before and after hip core decompression.

Methods: Study included participants with hip ON secondary to treatment for hematologic malignancy or sickle cell disease, between 8 and 29 years of age, requiring hip core decompression surgery. At 1-year follow-up, 13 participants (9 male, median age of 17 years) completed the Functional Mobility Assessment (FMA), range of motion, and GAITRite testing.

Results: The participants demonstrated improved mobility and endurance on the FMA at 1 year postoperatively compared with preoperatively, with higher scores for time on the Timed Up and Go (mean FMA score = 2.92 [SD = 1.32] vs 2.07 [SD = 1.70]), time on the Timed Up and Down Stairs (3.69 [0.85] vs 2.92 [1.66]), and 9-Minute Walk Test scores for distance walked (2.69 [0.63] vs 2.23 [0.93]) and heart rate (4.54 [0.66] vs 3.31 [1.38]). GAITRite analysis also showed improvements in many gait parameters at 1-year follow-up.

Limitations: Cancer treatment complications other than ON could have contributed to results, not all eligible participants agreed to participate, and follow-up was only 1 year.

Conclusions: Young patients with hip ON demonstrated improvements in functional mobility, endurance, and gait quality 1 year following hip core decompression.
Background: Patients with pediatric leukemia and sickle cell disease are at risk for developing osteonecrosis (ON), a disease that can result in pain, loss of function, and disability. Hip core decompression surgery is an option aimed to prevent femoral head collapse and avoid future arthroplasty.

Objective: Describe functional outcomes and gait quality among a young population with hip ON before and after hip core decompression.

Methods: ...

Leucémie ; Pédiatrie ; Oncologie

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The scientific scope of swallowing disorders in the neonatal and pediatric populations is growing exponentially; however, the preponderance of evidence for evaluation protocols has been concentrated in non-instrumental evaluations creating a lack of research about protocols for instrumental swallowing assessment. Thus, the purpose of this study was to systematically review the literature to identify and to report protocols used in instrumental assessments through videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) in the neonatal and pediatric populations to support clinical decision making. The search strategy was applied in five online databases, no filters were applied to restrict languages or publication dates and the gray literature was reviewed. PRISMA statement was used to guide the construction of this review. The studies included validated and unvalidated protocols, the validated protocols had their risk of bias estimated using the QUADAS-2. In total, 13 studies were included in the final review, of these eleven assessed through QUADAS-2, and two classified with low risk of bias. One study is in the process of standardization and validation of an instrumental assessment protocol for swallowing in bottle-fed infants through VFSS. Information about validity and reliability of published protocols for instrumental evaluation in the neonatal and pediatric populations is limited. Therefore, further research is needs to development studies aiming to standardize and validate protocols for instrumental assessments in these populations.
The scientific scope of swallowing disorders in the neonatal and pediatric populations is growing exponentially; however, the preponderance of evidence for evaluation protocols has been concentrated in non-instrumental evaluations creating a lack of research about protocols for instrumental swallowing assessment. Thus, the purpose of this study was to systematically review the literature to identify and to report protocols used in instrumental ...

Pédiatrie ; Néonatalogie ; Troubles de la déglutition

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Fluid management in hospitalized pediatric patients | Octobre 2022 H

Article (Nutrition clinique)

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The proper use of intravenous fluids has likely been responsible for saving more lives than any other group of substances. Proper use includes prescribing an appropriate electrolyte and carbohydrate solution, at a calculated rate or volume, for the right child, at the right time. Forming intravenous fluid plans for hospitalized children requires an understanding of water and electrolyte physiology in healthy children and how different pathology deviates from the norm. This review highlights fluid management in several disease types, including liver disease, diabetic ketoacidosis, syndrome of inappropriate antidiuretic hormone, diabetes insipidus, kidney disease, and intestinal failure as well as in those with nonphysiologic fluid losses. For each disease, the review discusses specific considerations, evaluations, and management strategies to consider when customizing intravenous fluid plans. Ultimately, all hospitalized children should receive an individualized fluid plan with recurrent evaluations and fluid modifications to provide optimal care.
The proper use of intravenous fluids has likely been responsible for saving more lives than any other group of substances. Proper use includes prescribing an appropriate electrolyte and carbohydrate solution, at a calculated rate or volume, for the right child, at the right time. Forming intravenous fluid plans for hospitalized children requires an understanding of water and electrolyte physiology in healthy children and how different pathology ...

Hospitalisation ; Pédiatrie

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Purpose: Approximately 25% of inflammatory bowel disease (IBD) patients are diagnosed in childhood and the incidence is increasing. Thus, more patients will transition to adult care in the future. Within the literature, transition readiness has been deemed important to achieving a successful transition; however, it is unclear what outcomes define success. This scoping review aims to summarize the literature on outcomes surrounding transition from pediatric to adult care in patients with IBD.

Methods: A scoping review was conducted with the following steps: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarizing, and reporting results, and (6) consultation with an additional researcher. Studies were identified from 5 databases and were included in part if (1) IBD was a disease of interest, (2) referred to transition as the movement and adjustment from pediatric to adult care, and (3) evaluated patient outcomes up to 5 years after first adult appointment and/or defined a successful or unsuccessful transition.

Results: Twenty-six peer-reviewed studies were included. Four studies defined transition success, while 2 studies defined an unsuccessful transition. Transition outcomes were categorized into these 6 themes: being comfortable in adult care (n = 4); health care utilization (n = 19); disease management (n = 15); knowledge (n = 5); quality of life (n = 6); self-efficacy (n = 7).

Conclusions: Most studies evaluated transition outcomes by themes of health care utilization (n = 19) and disease management (n = 15). Future research should focus on engaging patients along with providers in order to create a consensus on indicators of transition success.
Purpose: Approximately 25% of inflammatory bowel disease (IBD) patients are diagnosed in childhood and the incidence is increasing. Thus, more patients will transition to adult care in the future. Within the literature, transition readiness has been deemed important to achieving a successful transition; however, it is unclear what outcomes define success. This scoping review aims to summarize the literature on outcomes surrounding transition ...

Intestin - Maladies ; Syndrome de l'intestin irritable ; Pédiatrie

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Objective: The present study aims to explore the relative effectiveness of two group-based cognitive rehabilitation programs for reducing fatigue in pediatric acquired brain injury (pABI). Method: This is an exploratory study of secondary endpoints in a blinded, parallel-randomized controlled trial with children and adolescents (ages 10-17 years) with pABI and reported executive dysfunction. It investigates the effectiveness of a metacognitive program (pediatric goal management training, n = 36) compared to a psychoeducational program (pediatric brain health workshop, n = 37) for reducing fatigue (Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale), 8 weeks and 6 months postintervention. Results: Seventy-three participants completed the allocated interventions, and 71 attended the 6-month follow-up. The results showed a significant decrease in parent-reported fatigue for both interventions from baseline to the 6-month follow-up. Forty percent of the total sample had a reliable change. There was no significant difference between the intervention groups, but a tendency in favor of the psychoeducational approach. Only subscales cognitive and sleep/rest fatigue showed significant reductions. In regression analyses, several factors predicted fatigue at 6 months follow-up, but only better global outcome and executive attention predicted a decrease in fatigue symptoms after 6 months. Conclusions: Group-based cognitive rehabilitation in the chronic phase of pABI, including education of parents and teachers, may be helpful in reducing fatigue. Global outcome and executive attention at baseline predicted fatigue improvement. Developmental factors are important to consider when tailoring pediatric interventions, as well as modifiable factors associated with fatigue.
Objective: The present study aims to explore the relative effectiveness of two group-based cognitive rehabilitation programs for reducing fatigue in pediatric acquired brain injury (pABI). Method: This is an exploratory study of secondary endpoints in a blinded, parallel-randomized controlled trial with children and adolescents (ages 10-17 years) with pABI and reported executive dysfunction. It investigates the effectiveness of a metacognitive ...

Fatigue ; Pédiatrie ; Cerveau - Lésions et blessures

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Back to Basics : Lifestyle Interventions for Adolescent Depression | Septembre/Octobre 2022 H

Article (Psychiatrie)

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Learning objectives: After completing this activity, practitioners will be better able to:

* Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"

* Set up a process for providing effective interventions for the increased number of patients with adolescent depression

* Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand

Abstract: Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.
Learning objectives: After completing this activity, practitioners will be better able to:

* Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"

* Set up a process for providing effective interventions for the increased number of patients with adolescent depression

* Design or update their toolbox of treatment options for adolescents ...

Dépression chez l'adolescent ; Qualité de la vie ; Adolescents - Santé mentale ; Pédiatrie

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Abstract: Children and adolescents with high-risk (metastatic and relapsed) solid tumors have poor outcomes despite intensive multimodal therapy, and there is a pressing need for novel therapeutic strategies. Adoptive cellular therapy (ACT) has demonstrated activity in multiple adult cancer types, and opportunity exists to expand the use of this therapy in children. Employment of immunotherapy in the pediatric population has realized only modest overall clinical trial results, with success thus far restricted mainly to antibody-based therapies and chimeric antigen receptor T-cell therapies for lymphoid malignancy. As we improve our understanding of the orchestrated cellular and molecular mechanisms involved in ACT, this will provide biologic insight and improved ACT strategies for pediatric malignancies. This review focuses on ACT strategies outside of chimeric antigen receptor T-cell therapy, including completed and ongoing clinical trials, and highlights promising preclinical data in tumor-infiltrating lymphocytes that enhance the clinical efficacy of ACT for high-risk pediatric solid tumors.
Abstract: Children and adolescents with high-risk (metastatic and relapsed) solid tumors have poor outcomes despite intensive multimodal therapy, and there is a pressing need for novel therapeutic strategies. Adoptive cellular therapy (ACT) has demonstrated activity in multiple adult cancer types, and opportunity exists to expand the use of this therapy in children. Employment of immunotherapy in the pediatric population has realized only modest ...

Thérapie cellulaire ; Pédiatrie ; Tumeurs chez l'enfant

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Faire l'expérience de la transition de son enfant des soins curatifs vers les soins palliatifs | Juin 2022 H

Article (Soins palliatifs et soins spirituels)

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Accompagner vers la mort son enfant atteint de cancer et faire le deuil de celui-ci représente une expérience bouleversante et souffrante à laquelle aucun parent ne souhaite être confronté. En Amérique du Nord, plusieurs dizaines de milliers d’enfants vivent avec le cancer (Snaman et al., 2020). Au Canada, 20 % des enfants atteints de cancer ne survivront pas à leur maladie (Société canadienne du cancer, 2021). Les parents de ces enfants sont leurs proches aidants principaux. Toutefois, le processus psychologique et social que traversent les parents ainsi que leurs besoins psychosociaux durant la fin de vie de leur enfant atteint de cancer sont peu documentés. Le présent article présente une synthèse des connaissances sur l’expérience des parents qui accompagnent leur enfant atteint de cancer vers les soins de fin de vie dans une perspective psychosociale. Cette recension permet, dans un premier temps, de caractériser la transition des soins curatifs vers les soins palliatifs d’un enfant atteint de cancer avancé. Dans un deuxième temps, elle décrit les principaux facteurs psychosociaux qui influencent le vécu des parents à travers la trajectoire de soin de l’enfant, de l’annonce de la maladie jusqu’à la période de deuil. Enfin, des recommandations pour améliorer le soutien psychosocial offert aux parents tout au long de la trajectoire de soin de l’enfant malade, incluant la phase palliative et celle du deuil, sont proposées.
Accompagner vers la mort son enfant atteint de cancer et faire le deuil de celui-ci représente une expérience bouleversante et souffrante à laquelle aucun parent ne souhaite être confronté. En Amérique du Nord, plusieurs dizaines de milliers d’enfants vivent avec le cancer (Snaman et al., 2020). Au Canada, 20 % des enfants atteints de cancer ne survivront pas à leur maladie (Société canadienne du cancer, 2021). Les parents de ces enfants sont ...

Soins palliatifs ; ENFANTS ; Cancer ; Pédiatrie ; Parents et enfants

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Observation Versus Cast Treatment of Toddler's Fractures | Mai / Juin 2022 H

Article (Pédiatrie, néonatologie et périnatalité)

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Background: Nondisplaced metaphyseal fractures of the distal tibia, or toddler's fractures, are one of the most common pediatric injuries. Healing typically occurs quickly without sequelae. Treatment ranges from long leg cast immobilization to observation. This study compares short-term clinical and radiographic outcomes of toddler's fractures treated with long leg casting versus observation.

Methods: Patients with toddler's fractures were offered enrollment and randomization at diagnosis. Because many families opposed randomization, a preference arm was added after one year. All subjects were analyzed as a prospective cohort. Radiographs were obtained at diagnosis and 4 weeks. A modified Oxford Ankle Foot Questionnaire for Children (OAFQ-C) and family satisfaction survey were collected at diagnosis, 4 and 8 weeks. Scores were analyzed using mixed effect models. Family satisfaction surveys were compared using a Wilcoxon rank sum test.

Results: Forty-four subjects participated in the study, 34 (77%) in the preference arm and 10 (23%) in the randomized cohort. The median patient age was comparable between the cast and the observation groups, 2.0 versus 1.8 years, respectively. Significant improvement in OAFQ-C scores was observed in both groups over 8 weeks (P<0.01). Patients in the observation group had a higher initial play score than the cast group (P=0.03). The observation group trended toward higher physical scores at all time points (P=0.11). There was no significant difference in emotional scores between groups (P=0.77). No displacement was observed in any patient. Casted patients had significantly more minor complications with 4 patients requiring cast change or removal compared with 0 in the observed group (P=0.01). At 8 weeks, 80% of parents in the cast group were likely or very likely to choose the same treatment compared with 95.6% in the observation group. Family satisfaction scores did not differ between groups (P=0.18). They demonstrated differences in perceived normal walking at 4 weeks, with 50% of casted patients walking normally compared with 92% of observed patients. Over 90% of patients in both groups were reportedly walking normally at week 8.

Conclusion: Observation of toddler's fractures results in equivalent clinical and radiographic outcomes, high family satisfaction and fewer complications compared with treatment with a long leg cast.

Level of Evidence: Level II.
Background: Nondisplaced metaphyseal fractures of the distal tibia, or toddler's fractures, are one of the most common pediatric injuries. Healing typically occurs quickly without sequelae. Treatment ranges from long leg cast immobilization to observation. This study compares short-term clinical and radiographic outcomes of toddler's fractures treated with long leg casting versus observation.

Methods: Patients with toddler's fractures were ...

Fractures ; Traumatisme psychique chez l'enfant ; Pédiatrie

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Background: A small but significant number of children and adolescents with cancer experience severe physical and psychological distress. Previous studies have shown that drawing therapy positively affects relieving psychological problems. However, the effect of drawing therapy on pediatric oncology patients has not been established by systematic review.

Objective: The aim of this study was to determine the effect of drawing therapy on the pediatric oncology population.

Methods: PubMed, EMBASE, MEDLINE, Cochrane, PsycINFO, CINAHL, and Chinese databases including CNKI, Wanfang, VIP, and CBM were searched. Studies published in the English and Chinese languages up to December 2019 were screened, and randomized controlled trials and nonrandomized experimental studies of drawing therapy interventions for pediatric oncology patients were reviewed. Screening was undertaken independently by 2 reviewers. The review protocol was registered with PROSPERO (registration number: CRD42020178365).

Results: Eight studies were included. Three studies were randomized controlled trials, and 5 studies were nonrandomized experimental studies. Seven studies showed that drawing therapy had positive effects on reducing depression and anxiety and improving quality of life. However, 1 study showed a contradictory result, that is, participants had an increased anxiety level after intervention.

Conclusions: Drawing therapy is effective in improving negative emotions, relieving somatic symptoms, and increasing social communication for pediatric oncology patients.

Implications for Practice: Drawing therapy may be considered an adjuvant psychological intervention strategy for pediatric oncology patients. Meanwhile, more rigorous studies are needed to address the deficiencies of small number size and methodological weakness.
Background: A small but significant number of children and adolescents with cancer experience severe physical and psychological distress. Previous studies have shown that drawing therapy positively affects relieving psychological problems. However, the effect of drawing therapy on pediatric oncology patients has not been established by systematic review.

Objective: The aim of this study was to determine the effect of drawing therapy on the ...

Dessin - Emploi en thérapeutique ; Oncologie ; Pédiatrie ; Cancer chez l'enfant

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Background
Home enteral nutrition (HEN) use continues to increase in children unable to meet nutritional needs through oral intake. Some patients do not tolerate standard polymeric formula (SPF), which may lead to malnutrition. Use of peptide-based diet (PBD) has demonstrated benefits in adults, however there remains a paucity of data in pediatric population.

Methods
Retrospective review of medical records of children receiving HEN between October 2015 and October 2019 was conducted. Nutrition, tolerance, and healthcare utilization was tracked through May 2020. Children receiving PBD as initial formula or transitioned to PBD from SPF were included. Our objective was to assess gastrointestinal tolerance and impact on healthcare utilization in children receiving PBD.

Results
During study period, 30 children (mean age, 9 ± 5.44 years; 20 of 30 [66.7%] male) utilized PBDs. Twenty-one patients started PBD directly with malnutrition as primary indication. Nine patients transitioned from SPF to PBD, most often due to intolerance of SPF (66%). After transition to PBD, no symptoms were reported in 6 of 9 (66.7%) patients, and symptoms of SPF intolerance resolved in 4 of 9 (44.5%) patients. Healthcare utilization declined significantly after transition to PBD, including mean numbers of emergency room visits (0.78 ± 1.09 to 0.11 ± 0.33; P = .025), provider visits (1.67 ± 1.32 to 0.56 ± 0.73; P = .007), and phone calls (1.22 ± 1.39 to 0.33 ± 0.50; P = .026).

Conclusions
PBD is well tolerated and can result in significant reduction in healthcare utilization in children intolerant to SPF.
Background
Home enteral nutrition (HEN) use continues to increase in children unable to meet nutritional needs through oral intake. Some patients do not tolerate standard polymeric formula (SPF), which may lead to malnutrition. Use of peptide-based diet (PBD) has demonstrated benefits in adults, however there remains a paucity of data in pediatric population.

Methods
Retrospective review of medical records of children receiving HEN between ...

Soins à domicile ; Pédiatrie ; Nutrition

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Background and Objectives: Although the recent approval of selumetinib is expected to transform the management of children with neurofibromatosis type 1 (NF1), particularly those with symptomatic and inoperable plexiform neurofibromas, no systematic review has summarized its efficacy and safety based on the latest studies. This study was conducted to systematically evaluate the efficacy and safety of selumetinib in children with NF1.

Methods: Original articles reporting the efficacy and safety of selumetinib in patients with NF1 were identified in PubMed and EMBASE up to January 28, 2021. The pooled objective response rates (ORRs) and disease control rates (DCRs) were calculated using the DerSimonian-Laird method based on random-effects modeling. The pooled proportion of adverse events (AEs) was also calculated. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation system.

Results: Five studies involving 126 patients were included in our analysis. The studies had a very low to moderate quality of the evidence. The pooled ORR was 73.8% (95% CI 57.3%-85.5%) and the DCR was 92.5% (95% CI 66.5%-98.7%). The 2 most common AEs were diarrhea, which had a pooled rate of 63.8% (95% CI 52.9%-73.4%), and an increase in creatine kinase levels, which had a pooled rate of 63.3% (95% CI 35.6%-84.3%).

Discussion: Our results indicate that selumetinib is an effective and safe treatment for pediatric patients with symptomatic, inoperable plexiform neurofibromas. Further larger-scale randomized controlled studies are needed to confirm the long-term outcome of patients treated with this drug.
Background and Objectives: Although the recent approval of selumetinib is expected to transform the management of children with neurofibromatosis type 1 (NF1), particularly those with symptomatic and inoperable plexiform neurofibromas, no systematic review has summarized its efficacy and safety based on the latest studies. This study was conducted to systematically evaluate the efficacy and safety of selumetinib in children with NF1.

Methods: ...

Pédiatrie ; Système nerveux - Maladies ; Cerveau - Maladies

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Abstract: A 7-year-old girl with chronic active EBV (CAEBV) infection-associated hemophagocytic lymphohistiocytosis presented with fever. 18F-FDG PET/CT revealed heterogeneous FDG uptake in multiple muscle groups without significant abnormal activity elsewhere. On repeat FDG PET/CT scan 1 year later after therapy, the abnormal activity in muscles disappeared. Skeletal muscle involvement by CAEBV infection should be included as differential diagnosis for increased muscle activity on FDG PET/CT study.
Abstract: A 7-year-old girl with chronic active EBV (CAEBV) infection-associated hemophagocytic lymphohistiocytosis presented with fever. 18F-FDG PET/CT revealed heterogeneous FDG uptake in multiple muscle groups without significant abnormal activity elsewhere. On repeat FDG PET/CT scan 1 year later after therapy, the abnormal activity in muscles disappeared. Skeletal muscle involvement by CAEBV infection should be included as differential ...

Infection ; Pédiatrie ; Maladies à virus ; Imagerie médicale

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Acute severe respiratory syndrome coronavirus-2 treatment overview for pediatrics | Février 2022 H

Article (Pédiatrie, néonatologie et périnatalité)

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Purpose of review
The novel severe respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has caused a world-wide pandemic with devastating effects. Fortunately, most children display only mild-to-moderate symptoms, but there are a subset that will have severe symptoms warranting treatment. This review evaluates the current evidence for antiviral and anti-inflammatory treatment of acute SARS-COV-2 infections, including coronavirus disease 2019 in pediatrics.
Recent findings
Treatment recommendations continue to evolve with emerging results from clinical trials. Initial therapies were tailored to repurposed medications, and have now transitioned toward more specific antiviral therapy. In addition to specific antiviral therapy, there is also support to modulate the immune system and reduce inflammatory damage seen in coronavirus disease 2019. Much of the data result from adult studies with subsequent extrapolation to pediatrics.
Summary
Recommended therapy will continue to adapt as results return from clinical trials. A continued commitment from the National Institutes of Health and research community to assist in determining optimal therapies for pediatric patients is essential. Until then, most recommendations will likely be informed from the results seen in adult populations.
Purpose of review
The novel severe respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has caused a world-wide pandemic with devastating effects. Fortunately, most children display only mild-to-moderate symptoms, but there are a subset that will have severe symptoms warranting treatment. This review evaluates the current evidence for antiviral and anti-inflammatory treatment of acute SARS-COV-2 infections, including coronavirus disease 2019 in ...

COVID-19 ; Médicaments ; Pédiatrie ; Appareil respiratoire - Maladies

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Importance: The Mini-Clinical Evaluation Exercise (Mini-CEX) is highly recommended for assessing interns’ performance.

Objective: To develop a pediatric occupational therapy–specific Mini-CEX and examine its psychometrics.

Design: Stage 1 had a retrospective design; Stage 2 had a prospective design.

Setting: Pediatric occupational therapy unit in a hospital in Taiwan.

Participants: Thirty-four occupational therapy interns were evaluated with the Mini-CEX (physician version), and 57 were evaluated with the occupational therapy–specific Mini-CEX.

Outcomes and Measures: The occupational therapy–specific Mini-CEX was developed with seven items on a 9-point scale categorized into three levels (unsatisfactory, satisfactory, highly satisfactory).

Results: In Stage 1, the frequency of Mini-CEX (physician version) items receiving a rating of not applicable ranged from 1.9% to 88.1%. In Stage 2, the frequency of occupational therapy–specific Mini-CEX items receiving a rating of not applicable ranged from 3.5% to 31.6%. With the theme of evaluation taken into consideration, the frequency of not-applicable ratings was 0% to 8.8%. For the occupational therapy–specific Mini-CEX, content validity (item-level content validity index = 1, scale-level content validity index = 1) and internal consistency (Cronbach’s α = .93) were excellent. The interns’ scores on the second evaluation were significantly higher than those on their first evaluation, indicating good discriminant validity.

Conclusions and Relevance: The occupational therapy–specific Mini-CEX appears to be reliable and valid, and it is appropriate for evaluating interns’ skills and attitudes in pediatric occupational therapy practice.

What This Article Adds: The results support the development of the occupational therapy–specific Mini-CEX and its application in pediatric internship training.
Importance: The Mini-Clinical Evaluation Exercise (Mini-CEX) is highly recommended for assessing interns’ performance.

Objective: To develop a pediatric occupational therapy–specific Mini-CEX and examine its psychometrics.

Design: Stage 1 had a retrospective design; Stage 2 had a prospective design.

Setting: Pediatric occupational therapy unit in a hospital in Taiwan.

Participants: Thirty-four occupational therapy interns were evaluated with ...

Attitude (Psychologie) ; Ergothérapie ; Pédiatrie ; Mentorat

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Filtrer

Type
Auteurs

American Academy of Pediatrics [3]

Feld, Leonard G. [3]

Mahan, John D. [3]

Abzug, Mark J. [2]

Bourrillon, Antoine [2]

Brassard, Yvon [2]

Gousse, Hélène [2]

Hay Jr, William W. [2]

Hockenberry, Marilyn J. [2]

Lavertu, Éric [2]

Levin, Myron J. [2]

Rauch, Daniel A. [2]

Rodgers, Cheryl C. [2]

Weber, Michel [2]

Wilson, David [2]

Ashcraft, Keith W. [1]

Augustyn, Marilyn [1]

Bachur, Richard G. [1]

Battaile, Britta [1]

Behrman, Richard E. [1]

Benoist, Grégoire [1]

Blosser, Catherine G. [1]

Bockenhauer, Detlef [1]

Brady, Margaret A. [1]

Briard, Marie-Louise [1]

Brogan, Paul A. [1]

Bunik, Maya [1]

Burns, Catherine E. [1]

Cantey Basaniak, Nancy [1]

Chabrol, Brigitte [1]

Chamberlain, James M. [1]

Chéron, Gérard [1]

Chevalier, Bertrand [1]

Clayden, Graham [1]

Cousineau, Dominique [1]

Deterding, Robin R. [1]

Ditmar, Mark F. [1]

Driver, David [1]

Drupals, Megan [1]

Dunn, Ardys M. [1]

Dupuis, France [1]

Fresco, Olivier [1]

Gallet, Jean-Paul [1]

Garzon, Dawn Lee [1]

Gedeit, Rainer G. [1]

Gershel, Jeffrey C. [1]

Geyer, Jane [1]

Goldbloom, Richard B. [1]

Greenbaum, Larry A. [1]

Greer, Frank R. [1]

Haut, Catherine [1]

Hôpital Sainte-Justine [1]

Jackson, Mary Anne [1]

Kher, Karrwal K. [1]

Kleinman, Ronald E. [1]

Kliegman, Robert [1]

Kline-Tilford, Andrea [1]

Kurkowski, Jennifer [1]

Lacombe, Didier [1]

Lavelle, Jane [1]

Lissauer, Tom [1]

Long, Toby [1]

Lorenz, John M. [1]

Lyonnet, Stanislas [1]

Massé, Linda [1]

McInerny, Thomas K. [1]

Meadows-Oliver, Mikki [1]

Murphy, J. Patrick [1]

Nagler, Joshua [1]

Nelson, Waldo E. [1]

Nocton, James J. [1]

Ono, Jennie G. [1]

Oshimura, Jennifer [1]

Osorio, Snezana Nena [1]

Ostlie, Daniel J. [1]

Polin, Richard A. [1]

Rees, Lesley [1]

Schnaper, H. William [1]

Seigel, Warren M. [1]

Selbst, Steven M. [1]

Sénécal, Lyse [1]

Shaw, Kathy N. [1]

Sheng, Vanessa [1]

Shook, Joan E. [1]

Starr, Nancy Barber [1]

Thomas, Shari S. [1]

Toscano, Kathleen [1]

Turgeon, Jean [1]

Valleteau de Moulliac, Jérôme [1]

Ware, Matthaeus [1]

Webb, Nicholas J.A. [1]

Whitfield Holcomb, George, III [1]

Willson, Charles F. [1]

Young, Kimberly [1]

Zukerman, Barry [1]

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Date de parution
Descripteurs

Pédiatrie [74]

Enfants - Maladies [14]

Enfants - Maladies - Diagnostics [5]

Urgences en pédiatrie [5]

Cannabis [4]

Chirurgie [4]

Enfants - Maladies - Traitement [4]

Enfants - Santé et hygiène [4]

Maladies chroniques [4]

Soins infirmiers en pédiatrie [4]

Enfants - Développement [3]

Soins de santé primaires [3]

Système nerveux - Maladies [3]

Adolescents [2]

Appareil respiratoire - Maladies [2]

Appareil urinaire [2]

ENFANTS [2]

Imagerie médicale [2]

Infection [2]

Néonatalogie [2]

Néphrologie [2]

Nutrition [2]

Oncologie [2]

Performance [2]

Reins [2]

Reins - Physiologie [2]

Soins infirmiers en pédiatrie - Problèmes et exercices [2]

Adolescents - Maladies [1]

Adolescents - Santé et hygiène [1]

Adolescents - Santé mentale [1]

Adolescents - Usage des drogues [1]

Anémie [1]

Anesthésie [1]

Asthme chez l'enfant [1]

Attitude (Psychologie) [1]

Cancer [1]

Cancer chez l'enfant [1]

Cerveau - Lésions et blessures [1]

Cerveau - Maladies [1]

Chirurgie opératoire [1]

Coeur - Maladies [1]

COVID-19 [1]

Dépression chez l'adolescent [1]

Dermatologie [1]

Dermatologie pédiatrique [1]

Dessin - Emploi en thérapeutique [1]

Douleur - Traitement [1]

Douleur chez le nouveau-né [1]

Drogues - Effets physiologiques [1]

Enfants - Alimentation [1]

Enfants - chirurgie [1]

Enfants - Examens médicaux [1]

Enfants - Psychiatrie [1]

Enfants - Psychologie [1]

Enfants - Psychopathologie [1]

Enfants - Soins [1]

Enfants - Usage des drogues [1]

Enfants malades - Soins hospitaliers [1]

Ergothérapie [1]

Éthique médicale [1]

Fatigue [1]

Fractures [1]

Génétique médicale [1]

Gynécologie [1]

Hospitalisation [1]

Intestin - Maladies [1]

Jeunesse - Usage des drogues [1]

Leucémie [1]

Maladies à virus [1]

Maladies génétiques [1]

Maladies infectieuses - Traitement [1]

Malformations [1]

Médecine d'urgence [1]

Médecine de l'adolescence [1]

Médecine familiale [1]

Médecine préventive [1]

Médicaments [1]

Mentorat [1]

Neurologie pédiatrique [1]

Nourrissons - Alimentation [1]

Nouveau-nés - Alimentation [1]

Nouveaux-nés - Soins médicaux [1]

Obésité [1]

Parents et enfants [1]

Peau - Maladies - Traitement [1]

Pédiatrie - Aspect moral [1]

Pédiatrie - Dictionnaires français [1]

Pharmacologie clinique [1]

Physiothérapie [1]

Prématurés - Alimentation [1]

PSYCHIATRIE [1]

Qualité de la vie [1]

Radiographie (Médecine) [1]

Relations interprofessionnelles [1]

Santé publique [1]

Soins à domicile [1]

SOINS INFIRMIERS [1]

Soins intensifs en pédiatrie [1]

Soins palliatifs [1]

Syndrome de l'intestin irritable [1]

Thérapie cellulaire [1]

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