Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
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The pharmacokinetics and pharmacodynamics of the main antifungal drugs used for invasive fungal infections (amphotéricin B, flucytosine, triazole compounds, echinocandins) have been more or less completely investigated in the paediatric population. This article reviews the pharmacokinetic profiles of these drugs in children, with a focus on the age-related changes. The concentration/efficacy relationships that were evidenced in children are also described.
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Ischemic stroke is rare in children, most of which occur in the supratentorial brain, and infratentorial infarcts are very rare. Some clinical manifestations may be similar but others such as ataxia and cranial nerve palsy are more specific. Vertebral artery dissection is the most frequent cause of stroke in the vertebrobasilar territory, but the cause most often remains unknown in children. ⋯ The third observation is a 6-year-old girl who suddenly exhibited cephalalgia, ataxia, and left visual impairment. The brain MRI revealed left occipital and cerebellar strokes due to vertebral artery dissection. The authors recommend the systematic search for vertebral artery dissection in cases of infratentorial stroke.
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To estimate the incidence and describe the clinical presentation and outcome (steroid responsiveness, clinical course, complications) of idiopathic nephrotic syndrome in children in a population-based retrospective study. ⋯ The incidence and outcome of idiopathic nephrotic syndrome in Gironde are comparable to the rates found in other studies. The disease may have a long course and the time for response to steroids at disease onset is the main predictor of steroid dependency and of use of non steroid agents.
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Fungal colonization in cystic fibrosis patient is frequent and dominated by Aspergillus fumigatus (A. fumigatus). Mycological analysis on specific media showed other filamentous species Scedosporium, Geosmithia argillacea. Prospective studies are necessary to appreciate prevalence and pathogenicity in this pathology. ⋯ Oral corticotherapy is the cornerstone of therapy but adverse effects are more frequent in cystic fibrosis. Antifungal therapy has a corticosteroid-sparing effect. New therapeutic strategies have to be evaluated.
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This review concentrates on the best evidence emerging in recent years on cerebral palsy prevention by administration of magnesium sulfate in mothers at risk of pre-term birth before 33-34 weeks' gestation. It was shown in the Cochrane database and in 3 meta-analyses of 5 randomized trials (Magpie Trial [neuroprotection of the pre-eclamptic mother], MagNet [neuroprotection/other intent: tocolysis], ActoMgSO(4) [neuroprotection], PreMag [neuroprotection], and Beam [neuroprotection]) that prenatal low-dose magnesium sulfate given to mothers at risk of pre-term birth has no severe deleterious effects in mothers and does not increase pediatric mortality in very pre-term infants. Moreover, it has significant neuroprotective effects on the occurrence of cerebral palsy at 2 years of age (relative risk, 0.69; 95% confidence interval, 0.54-0.87) and, in the neuroprotection subgroup, on the combined outcome of pediatric mortality or cerebral palsy (relative risk: 0.85; 95% confidence interval: 0.74-0.98). The number needed to treat (NTT) to prevent 1 case of cerebral palsy was 63 (95% CI, 39-172) and the NTT for an extra survivor free of cerebral palsy in the neuroprotection subgroup was 42 (95% CI, 22-357), justifying that magnesium sulfate should be discussed as a stand-alone treatment or as part of a combination treatment.