Olivier Mouterde

Epidemiology of Acute Viral Gastroenteritis in Children Hospitalized in Rouen, France

This study assessed the epidemiologic characteristics of acute viral gastroenteritis in hospitalized children. A stool sample obtained from each child was analyzed for the presence of astrovirus, calicivirus, rotavirus, adenovirus, enterovirus, and digestive bacteria. Of the 438 stool samples obtained, 138 tested positive for > or =1 pathogen during the winters of 1997-1998 and 1998-1999 (P<.001). Virologic tests revealed rotavirus in 17.3% of samples, calicivirus in 7.3%, astrovirus in 6.8%, adenovirus in 0.7%, and > or =1 virus in 5.4%. Median age was higher for patients with rotavirus gastroenteritis than it was for those with astrovirus or calicivirus gastroenteritis (P=.014). Mean duration of hospitalization was statistically significantly lower for children with rotavirus gastroenteritis (P=.022), despite the more-frequent dehydration observed among children with rotavirus versus those with astrovirus or calicivirus gastroenteritis (P=.007). In contrast, enteral rehydration was more rapidly achieved in patients with gastroenteritis due to rotavirus.

A Dose Determination Study of Polyethylene Glycol 4000 in Constipated Children: Factors Influencing the Maintenance Dose

Objectives: To determine the doses of polyethylene glycol (PEG) 4000 without additional salts allowing normal bowel habits in childhood functional constipation. Methods: This multicenter noncomparative study allocated children to 4 groups: 6-12 months, 13 months-3 years, 4-7 years, and 8-15 years. Constipation was defined as <1 stool/d for more than 1 month in children aged 6-12 months and <3 stools/w for more than 3 months in older children. Children randomly received either a nominal or a double starting dose. Treatment scheduled for 3 months could be adapted. Data were collected daily by the parents and rated at each visit by the investigator. Results: In the 96 children included, the median (interquartile) effective daily doses were by groups; 3.75 (2.50-5.00) g, 6.00 (4.00-7.43) g, 11.71 (7.00-16.00) g, and 16.00 (16.00-24.00) g, respectively, i.e., around 0.50 g/day/kg with a potential increment of the maintenance dose with higher initial dosages. More children had a final dosage identical to the initial one when started on the nominal dose (73%) than with the double one (42%, P < 0.003). More than 90% of children recovered normal bowel habits. Fecal soiling ceased in >60% of children with this symptom at enrolment. Fecal mass in the rectum and abdominal pain were markedly reduced and appetite improved. Conclusions: A daily dose of PEG 4000 around 0.50 g/day/kg in children aged 6 months to 15 years is effective in more than 90% of constipated children and 60% of those with fecal soiling.

Gastric secretion in infants : application to the study of sudden infant death syndrome and apparently life-threatening events

Sudden infant death is a problem of paediatric public health which remains an unpredictable phenomenon of unknown aetiology. Many authors have discussed the role of a neurovegetative aetiology, the role of the vagus nerve being suspected above all. A biological approach to vagal tone was attempted by assaying intragastric pepsin and serum pepsinogen and calculating the ratio of pepsin to acid in control infants, and by assaying serum pepsinogen levels in infants having suffered an apparently life-threatening event (ALTE) or who died of the sudden infant death syndrome (SIDS). This study showed that the age of 2 months appears to be a turning point in the development of digestive secretions, an age when the risk of SIDS is at its peak, and that the rates of the selected biological markers are significantly higher in victims of SIDS or ALTE than in controls. The predictive value of these biological markers is currently under evaluation.

Efficacy and safety of adalimumab after infliximab failure in pediatric Crohn disease.

Objectives: The objective of the present study was to evaluate the effectiveness and safety of adalimumab (ADA) in children with Crohn disease (CD) who experienced infliximab (IFX) failure at the population level. Methods: The present retrospective study included all of the children with CD from a pediatric-onset population-based cohort who received ADA before 18 years because of IFX failure or intolerance. Efficacy of ADA was evaluated using the physicians global assessment score, C-reactive protein and orosomucoid, and nutritional and growth indicators. Results: A total of 27 children with CD received ADA. Median age at CD diagnosis and at ADA initiation was 11 years (Q1 = 9; Q3 = 12) and 15 years (12; 15), respectively. After a median follow-up of 16 (8; 26) months after ADA initiation, ADA had clinical benefit as measured by the physical global assessment score in 19 patients (70%). Cumulative probability of failure to ADA treatment was 38% at 6 months and 55% at 1 year. Eight patients had a primary failure (30%) and 5 of 19 (26%) a secondary failure to ADA. Furthermore, 11 patients (40%) experienced a total of 19 adverse effects. No serious adverse effects were observed and none resulted in ADA discontinuation. There was no significant change in growth and nutritional patterns during the study period, but we found a significant decrease in median C-reactive protein (15 mg/L [4; 44] vs 9 mg/L [3; 19]; P = 0.05) and orosomucoid (1.6 g/L [1.5; 2.6] vs 1.1 g/L [0.8; 1.9]; P = 0.001) from ADA initiation to maximal follow-up in patients responding to ADA. Conclusions: In the present population-based cohort of pediatric-onset CD with IFX failure, treatment with ADA was safe and effective in two-thirds of patients.

Complications of the digestive tract in varicella infection including two cases of erosive gastritis

We conducted a retrospective study over a 16-year period (1987–2002) in one paediatric unit in France to evaluate digestive complications of varicella infection. A total of 247 reported in 309 immunocompetent children (mean age 2.8 years) admitted for varicella, were: digestive (30%), neurological (28%), bronchopulmonary (21%), and cutaneous (21%). The digestive complications consisted of food intolerance (vomiting and/or failure to take food by mouth; 33%), gingivitis-stomatitis (31%), diarrhoea (25%), and 11% were classified as miscellaneous. Mucosal damage was described as mouth erosion in children with gingivitis-stomatitis. Lower and deeper lesions of the digestive mucosa were identified. Gastric endoscopy, performed in two children who had presented with bloody vomiting, revealed erosive gastritis (Fig. 1). At the time of the investigation, the two children had typical cutaneous lesions highly suggestive of varicella. We believed that the findings of such gastric lesions did not justify the isolation of the varicella virus in the lesions. Causes other than varicella (coagulopathy, medication) were excluded: the two children had a normal coagulation test and had not received medication except paracetamol for fever (no non-steroidal anti-inflammatory drugs or acetylsalicylic acid). The true burden of digestive complications of varicella is often underestimated. In our study, they were the most frequently reported complication (30%). Galil et al. [2] reported a digestive tract complication rate of 19.3%. Bonhoeffer et al. [1] found a dehydration rate of 12%. Kremp et al. [3] reported a gingivitis-stomatitis rate of 24%. Digestive mucosal damage, described as mouth erosion, has often been reported in cases of gingivitis-stomatitis. According to our knowledge, lower and deeper lesions of the digestive mucosa with an erosive gastritis aspect in the course of varicella infection have not been reported in the literature. Varicella infection may also involve the gastrointestinal tract as well as the oral cavity.

Salivary transmission in an intrafamilial cluster of hepatitis B.

The major modes of transmission of hepatitis B virus are sexual contact, parenteral drug use, transfusion, and vertical transmission. Horizontal transmission has been demonstrated, but its mechanisms remain poorly understood. We report intrafamilial infection in which two siblings were infected by horizontal transmission, probably from ingestion of contaminated saliva. Acute hepatitis B virus (HBV) infection was diagnosed in a child, a father, and two mothers from an African family that included 17 children, all living together in France. Family serologies revealed that a second child had subclinical acute HBV infection, nine siblings were chronic HBV carriers, and five other siblings had infections that resolved spontaneously. The last child, a 1-month-old neonate, was healthy and had been immunized at birth. Horizontal transmission of (HBV) was suspected in the two children with acute disease; no other mode of contamination was suspected. These children were too old to have been contaminated from direct mother-tochild transmission and had not been transfused. They had no percutaneous skin wounds and had not recently traveled. Their infection was probably explained by this African family’s habit of eating meals with their fingers from the same bowl. Means of transmission could not be determined for the other siblings because their period of acute infection was unknown. This case demonstrates intrafamilial HBV contamination and supports the hypothesis that this virus can be transmitted by human saliva.

Association of N-acetylcysteine and glucagon during percutaneous cholangiography in the treatment of inspissated bile syndrome.

Inspissated bile syndrome (IBS) is a rare neonatal disease. In the majority of cases, it resolves spontaneously and treatment is conservative. Follow-up is recommended with close monitoring of laboratory tests. When IBS does not resolve spontaneously, a catheter can be inserted into the gallbladder for cholangiography, which allows irrigation and drainage. Despite this treatment, some biliary tract obstruction may persist. We report on the case of a 3-month-old infant whose continuous biliary obstruction caused by IBS was successfully managed by interventional radiology with the association of N-acetylcysteine and glucagon. Even as first-line agents, these would allow more rapid clearance of gallstones and prevent infectious complications of indwelling catheters as well as decrease the need for surgery.