Les diarrhées aiguës, en particulier à rotavirus, sont un problème fréquent en pédiatrie. Même si... more Les diarrhées aiguës, en particulier à rotavirus, sont un problème fréquent en pédiatrie. Même si la mortalité en Suisse est exceptionnelle et sans comparaison avec celle observée dans les pays en développement, la morbidité est cependant notable. Il n’existe actuellement aucun médicament en appoint à la réhydratation orale ou intraveineuse efficace en Suisse pour traiter les diarrhées aiguës des enfants. L’oligoélément zinc a prouvé son efficacité dans plusieurs pays en voie de développement depuis de nombreuses années (figure 1).1 Il diminue la gravité, la fréquence et le volume des diarrhées.2-4 Des études cliniques récentes et une revue Cochrane montrent également un bénéfice des supplémentations en zinc pour renforcer l’immunité et réduire les infections chez les enfants.5,6 Parallèlement aux efforts entrepris autour de la vaccination contre le rotavirus, l’évaluation et l’administration de zinc, comme armes thérapeutiques dans les diarrhées aiguës chez l’enfant de moins de cin...
BACKGROUND Children younger than 36 months with fever without a source (FWS) are at risk of serio... more BACKGROUND Children younger than 36 months with fever without a source (FWS) are at risk of serious bacterial infections (SBI). The risk of occult bacteremia (OB) has been greatly reduced in vaccinated children. The aim of this study is to describe the epidemiology of SBI in children with FWS in our setting and to evaluate the performance of our management algorithm. METHODS We designed a prospective cohort study. We included children aged 0-36 months presenting with FWS in our emergency unit. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Information on clinical evolution, final diagnosis, and immunization history were obtained after 10 days. Potential predictors of SBI were compared between patients with and without SBI. RESULTS Between October 2015 and September 2017, 173 children were recruited, with a median age of 4.4 months (2.1-1). Of these children, 166 (96%) were up to date with their vaccinations. A total of 47 children (27%) had a final diagnosis of SBI, which were all urinary tract infections (UTI). Presence of chills (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.3-24.3), fever for>2 days (OR 29.1, 95% CI 3.5-243.5), and age<9 months (OR: 45.3, 95% CI: 4.9-415.7) were statistically significant predictors of UTI in a multivariate logistic regression. The sensitivity and specificity of our management algorithm were 100% (95% CI: 92.4-100%) and 21.4% (14.6-29.6%), respectively. CONCLUSIONS In the setting of high vaccination coverage, we only identified SBI related to UTIs. We could not identify any OB. Our management algorithm was able to identify all SBI, but specificity was low. Refined criteria for screening of UTI could slightly increase this.
Abstract Introduction: Correct technique with a pressurized metered-dose inhaler (pMDI) equipped ... more Abstract Introduction: Correct technique with a pressurized metered-dose inhaler (pMDI) equipped with a valved holding chamber (VHC) or spacer provides an important advantage for adequate control of asthma and virus-induced wheezing in young children. The aim of this study was to assess the ability and knowledge of physicians and nurses to use a pMDI with a masked VHC in two pediatric emergency units. Methods: Study design: Two-center observational study. Inhaler use technique was assessed in 50 physicians and 50 nurses using a child mannequin and a validated videotaped nine-step scoring method. The participants’ knowledge was evaluated by a questionnaire. Results: The inhalation technique was perfectly mastered by 49% of the study participants and almost perfectly mastered by another 34% (mean score 8.3 ± 0.7; range 5–9). Nurses were more likely than doctors to demonstrate the technique perfectly (66% vs. 32%, p < 0.05). The two most common errors were forgetting to shake the pMDI between two consecutive puffs (38% of the participants) and putting the patient in an incorrect position (11%). About half of the participants reported that they checked each patient’s inhalation technique at every opportunity and knew how to clean the VHC. A large majority did not employ a reliable method to determine the amount of medication remaining in pMDIs without a counter. Conclusion: Healthcare professionals’ practical skills and knowledge on inhalation therapy were not completely mastered and could be improved with a mandatory training program.
ObjectivesTo investigate whether nebulised hypertonic saline (HS) treatment would decrease length... more ObjectivesTo investigate whether nebulised hypertonic saline (HS) treatment would decrease length of hospital stay (LOS) among infants with moderate-to severe-bronchiolitis compared with standard supportive care (SC).MethodsWe conducted an open, multicentre, randomised clinical trial from 1 April 2013 to 31 March 2016, in Swiss children’s hospitals. Patients aged 6 weeks to 24 months with a primary diagnosis of moderate or severe bronchiolitis were included. Children with previous episodes of wheezing, cardiac disease, chronic respiratory disease, immunodeficiency, prematurity (gestational age <34 weeks), corticotherapy in the preceding 2 weeks or inhaled bronchodilators within 24 hours before presentation were excluded. Patients were randomised to receive standard SC with nebulisation of 4 mL of 3% sodium chloride every 6 hours versus SSC. Main outcomes and measures were LOS duration of oxygen therapy, transfer to intensive care unit (ICU), readmission within 7 days following di...
Introduction La prevalence du syndrome hemolytique et uremique (SHU) associe a des infections inv... more Introduction La prevalence du syndrome hemolytique et uremique (SHU) associe a des infections invasives a pneumocoque (IIP) semble augmenter ces dernieres annees. Nous rapportons ici l’observation d’une enfant presentant un SHU suite a une pneumonie severe. Cas clinique Une enfant de 2 ans, vaccinee avec 3 doses de Prevenar 13, est hospitalisee dans un contexte de pneumonie bilaterale traitee par acide clavulanique-amoxicilline iv. Douze heures apres, elle developpe un ictere, des oedemes et une anurie. Le bilan biologique revele une anemie hemolytique, une thrombopenie, une insuffisance renale aigue, une cytolyse et une cholestase hepatique aigue. Elle beneficie d’une dialyse peritoneale et de transfusions de produits sanguins laves. Les hemocultures isolent un Streptococcus pneumoniae de sous-type 3, contenu dans le Prevenar 13. L’evolution est favorable avec normalisation de la fonction hepatique et renale 10 jours apres. Discussion Le SHU complique moins de 0,6% des IIP, essentiellement chez l’enfant de moins de 2 ans. Les complications renales sont plus frequentes et la mortalite est plus elevee (12%) que dans le SHU typique. Conclusion Cette observation met en evidence l’importance d’evoquer un SHU comme complication possible des IIP, meme chez les patients correctement vaccines.
The COVID-19 pandemic has deteriorated key determinants of health and caused major upheavals arou... more The COVID-19 pandemic has deteriorated key determinants of health and caused major upheavals around the world. Children, although less directly affected by the virus, are paying a heavy price through the indirect effects of the crisis, including poor diet, mental health impact, social isolation, addiction to screens and lack of schooling and health care, particularly among vulnerable groups. This paper is aimed at discussing the potential impact of this pandemic on children’s nutrition and lifestyle. Preliminary data from the literature and from our survey show significant disruptions in nutrition and lifestyle habits of children. While undernutrition is expected to worsen in poor countries, obesity rates could increase in middle- and high-income countries especially among precarious groups widening the gap in health and social inequalities.The real impact of the COVID-19 pandemic on children extends well beyond that of a viral infection. This crisis has public health implications t...
Ambulatory paediatric clinic in Lausanne, Switzerland, a country with a significant proportion of... more Ambulatory paediatric clinic in Lausanne, Switzerland, a country with a significant proportion of tuberculosis (TB) among immigrants. To assess the factors associated with positive tuberculin skin tests (TST) among children examined during a health check-up or during TB contact tracing, notably the influence of BCG vaccination (Bacille Calmette Guérin) and history of TB contact. A descriptive study of children who had a TST (2 Units RT23) between November 2002 and April 2004. Age, sex, history of TB contact, BCG vaccination status, country of origin and birth outside Switzerland were recorded. Of 234 children, 176 (75%) had a reaction equal to zero and 31 (13%) tested positive (>10 mm). In a linear regression model, the size of the TST varied significantly according to the history of TB contact, age, TB incidence in the country of origin and BCG vaccination status but not according to sex or birth in or outside Switzerland. In a logistic regression model including all the recorde...
Children love to play; play is their favorite occupation. They flourish through this millennial o... more Children love to play; play is their favorite occupation. They flourish through this millennial occupation. Play promotes harmonious development while integrating principles of social life. It is a solid barrier against the growing harms of sedentary lifestyle. The evolution of our societies is marked from the earliest age by a breathtaking decrease in the amount of movement and playtime of children. The consequences are known: delayed psychomotor development, psychological disorders, progression of obesity. Children of pre-carious and vulnerable families are the first victims. This review high-lights some of the essential knowledge related to the importance of play in children aged 0 to 5 years and attempts to suggest issues for recovering from a compromised situation. Solutions are individual, family and societal. The essential role of the family physician is specified.
Respiratory disease and acute respiratory difficulties are life threatening problems frequently m... more Respiratory disease and acute respiratory difficulties are life threatening problems frequently met in paediatric medicine. Since parents often call their doctor first, telephone triage is important in the correct management of children with respiratory distress. On arrival in the office or the emergency department, a child with dyspnea should rapidly be assessed for signs of severity and respiratory compromise. Oxygenation and early initiation of specific treatment are priorities in the management. Only a simple and rigorous clinical process, based on the essential, will reach all these objectives without delay. As soon as the child's situation is stabilised, the doctor decides what are the appropriate modalities for transfer. This article aims at reviewing these different issues.
Background Vasoactive drug preparation for continuous infusion in children is both complex and ti... more Background Vasoactive drug preparation for continuous infusion in children is both complex and time consuming and places the paediatric population at higher risk than adults for medication errors. We developed a mobile device application (app) as a step-by-step guide for the preparation to delivery of drugs requiring continuous infusion. The app has been previously tested during simulation-based resuscitations in a previous single-centre trial. In this trial, our aim was to assess this app in various hospital settings. Methods We did a prospective, multicentre, randomised, controlled, crossover trial to compare this app with an internationally used drug-infusion-rates table for the preparation of continuous drug infusion during standardised, simulation-based, paediatric post-cardiac arrest scenarios using a high-fidelity manikin. The scenarios were split into two study periods to assess the two preparation methods consecutively, separated by a washout distraction manoeuvre. Nurses in six paediatric emergency centres in Switzerland were randomly assigned (1:1) to start the scenario with either the app or the infusion-rates table and then complete the scenario using the other preparation method. The primary endpoint was the proportion of participants committing a medication error, which was defined as a deviation from the correct weight dose of more than 10%, miscalculation of the infusion rate, misprogramming of the infusion pump, or the inability to calculate drug dosage without calculation and guidance help from the study team. The medication error proportions observed with both preparation methods were compared by pooling both study periods, with paired data analysed using the unconditional exact McNemar test for dependent groups with a two-sided α level of 0•05. We did sensitivity analyses to investigate the carryover effect. This trial is registered with ClinicalTrials.gov, number NCT03021122. Findings From March 1 to Dec 31, 2017, we randomly assigned 128 nurses to start the scenario using the app (n=64) or the infusion-rates table (n=64). Among the 128 drug preparations associated with each of the two methods, 96 (75%, 95% CI 67-82) delivered using the infusion-rates table were associated with medication errors compared with nine (7%, 3-13) delivered using the mobile app. Medication errors were reduced by 68% (95% CI 59-76%; p<0•0001) with the app compared with the table, as was the mean time to drug preparation (difference 148•2 s [95% CI 124•2-172•1], a 45% reduction; p<0•0001) and mean time to drug delivery (168•5 s [146•1-190•8], a 40% reduction; p<0•0001). Hospital size and nurses' experience did not modify the intervention effect. We detected no carryover effect. Interpretation Critically ill children are particularly vulnerable to medication errors. A mobile app designed to help paediatric drug preparation during resuscitation with the aim to significantly reduce the occurrence of medication errors, drug preparation time, and delivery time could have the potential to change paediatric clinical practice in the area of emergency medicine.
Lactic acidosis is a common complication of status asthmaticus in adults. However, data is sparse... more Lactic acidosis is a common complication of status asthmaticus in adults. However, data is sparse in children. The aim of this study was to describe the prevalence and risk factors for lactic acidosis in children hospitalised for acute moderate or severe asthma. A total of 154 children 2–17 years of age were enrolled in a prospective observational study conducted in a tertiary hospital. All had capillary blood gas assessment 4 h after the first dose of salbutamol in hospital. The primary endpoint was the prevalence of lactic acidosis. Potential contributing factors such as age, sex, BMI, initial degree of asthma severity, type of salbutamol administration (nebuliser or inhaler), steroids, ipratropium bromide, and glucose-containing maintenance fluid represented secondary endpoints. All in all, 87% of patients had hyperlactatemia (lactate concentration > 2.2 mmol/l). Lactic acidosis (lactate concentration > 5 mmol/l and anion gap ≥ 16 mmol/l) was observed in 26%. In multivariat...
ABSTRACTBackgroundSaliva RT-PCR is an attractive alternative for the detection of SARS-CoV-2 in a... more ABSTRACTBackgroundSaliva RT-PCR is an attractive alternative for the detection of SARS-CoV-2 in adults with much less known in children.MethodsChildren and adolescents with symptoms suggestive of COVID-19 were prospectively enrolled in a comparative clinical trial of saliva and nasopharyngeal (NP) RT-PCR between November and December 2020. Detection rates and sensitivities of saliva and NP RT-PCR were compared. Participants with discordant NP and saliva RT-PCR results including viral load (VL) were also analyzed.ResultOut of 405 patients enrolled, 397 patients had two tests performed. Mean age was 12.7 years (range 1.2-17.9). Detection rates were 22.9% (95%CI 18.8-27.1%) by saliva RT-PCR, 25.4% (21.2-29.7%) by NP RT-PCR, and 26.7% (22.4-31.1%) by any test. The sensitivity of saliva was 85.2% (78.2-92.1%) when using NP as the gold standard; in contrast, when saliva was considered the gold standard, the sensitivity of NP was 94.5% (89.8-99.2%).For a NP RT-PCR VL threshold of ≥103 and ...
The name of the first author of the above mentioned published article has a double last name. The... more The name of the first author of the above mentioned published article has a double last name. The family name should have been "Ruman-Colombier" instead of "Ruman". The original article has been corrected. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Les diarrhées aiguës, en particulier à rotavirus, sont un problème fréquent en pédiatrie. Même si... more Les diarrhées aiguës, en particulier à rotavirus, sont un problème fréquent en pédiatrie. Même si la mortalité en Suisse est exceptionnelle et sans comparaison avec celle observée dans les pays en développement, la morbidité est cependant notable. Il n’existe actuellement aucun médicament en appoint à la réhydratation orale ou intraveineuse efficace en Suisse pour traiter les diarrhées aiguës des enfants. L’oligoélément zinc a prouvé son efficacité dans plusieurs pays en voie de développement depuis de nombreuses années (figure 1).1 Il diminue la gravité, la fréquence et le volume des diarrhées.2-4 Des études cliniques récentes et une revue Cochrane montrent également un bénéfice des supplémentations en zinc pour renforcer l’immunité et réduire les infections chez les enfants.5,6 Parallèlement aux efforts entrepris autour de la vaccination contre le rotavirus, l’évaluation et l’administration de zinc, comme armes thérapeutiques dans les diarrhées aiguës chez l’enfant de moins de cin...
BACKGROUND Children younger than 36 months with fever without a source (FWS) are at risk of serio... more BACKGROUND Children younger than 36 months with fever without a source (FWS) are at risk of serious bacterial infections (SBI). The risk of occult bacteremia (OB) has been greatly reduced in vaccinated children. The aim of this study is to describe the epidemiology of SBI in children with FWS in our setting and to evaluate the performance of our management algorithm. METHODS We designed a prospective cohort study. We included children aged 0-36 months presenting with FWS in our emergency unit. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Information on clinical evolution, final diagnosis, and immunization history were obtained after 10 days. Potential predictors of SBI were compared between patients with and without SBI. RESULTS Between October 2015 and September 2017, 173 children were recruited, with a median age of 4.4 months (2.1-1). Of these children, 166 (96%) were up to date with their vaccinations. A total of 47 children (27%) had a final diagnosis of SBI, which were all urinary tract infections (UTI). Presence of chills (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.3-24.3), fever for>2 days (OR 29.1, 95% CI 3.5-243.5), and age<9 months (OR: 45.3, 95% CI: 4.9-415.7) were statistically significant predictors of UTI in a multivariate logistic regression. The sensitivity and specificity of our management algorithm were 100% (95% CI: 92.4-100%) and 21.4% (14.6-29.6%), respectively. CONCLUSIONS In the setting of high vaccination coverage, we only identified SBI related to UTIs. We could not identify any OB. Our management algorithm was able to identify all SBI, but specificity was low. Refined criteria for screening of UTI could slightly increase this.
Abstract Introduction: Correct technique with a pressurized metered-dose inhaler (pMDI) equipped ... more Abstract Introduction: Correct technique with a pressurized metered-dose inhaler (pMDI) equipped with a valved holding chamber (VHC) or spacer provides an important advantage for adequate control of asthma and virus-induced wheezing in young children. The aim of this study was to assess the ability and knowledge of physicians and nurses to use a pMDI with a masked VHC in two pediatric emergency units. Methods: Study design: Two-center observational study. Inhaler use technique was assessed in 50 physicians and 50 nurses using a child mannequin and a validated videotaped nine-step scoring method. The participants’ knowledge was evaluated by a questionnaire. Results: The inhalation technique was perfectly mastered by 49% of the study participants and almost perfectly mastered by another 34% (mean score 8.3 ± 0.7; range 5–9). Nurses were more likely than doctors to demonstrate the technique perfectly (66% vs. 32%, p < 0.05). The two most common errors were forgetting to shake the pMDI between two consecutive puffs (38% of the participants) and putting the patient in an incorrect position (11%). About half of the participants reported that they checked each patient’s inhalation technique at every opportunity and knew how to clean the VHC. A large majority did not employ a reliable method to determine the amount of medication remaining in pMDIs without a counter. Conclusion: Healthcare professionals’ practical skills and knowledge on inhalation therapy were not completely mastered and could be improved with a mandatory training program.
ObjectivesTo investigate whether nebulised hypertonic saline (HS) treatment would decrease length... more ObjectivesTo investigate whether nebulised hypertonic saline (HS) treatment would decrease length of hospital stay (LOS) among infants with moderate-to severe-bronchiolitis compared with standard supportive care (SC).MethodsWe conducted an open, multicentre, randomised clinical trial from 1 April 2013 to 31 March 2016, in Swiss children’s hospitals. Patients aged 6 weeks to 24 months with a primary diagnosis of moderate or severe bronchiolitis were included. Children with previous episodes of wheezing, cardiac disease, chronic respiratory disease, immunodeficiency, prematurity (gestational age <34 weeks), corticotherapy in the preceding 2 weeks or inhaled bronchodilators within 24 hours before presentation were excluded. Patients were randomised to receive standard SC with nebulisation of 4 mL of 3% sodium chloride every 6 hours versus SSC. Main outcomes and measures were LOS duration of oxygen therapy, transfer to intensive care unit (ICU), readmission within 7 days following di...
Introduction La prevalence du syndrome hemolytique et uremique (SHU) associe a des infections inv... more Introduction La prevalence du syndrome hemolytique et uremique (SHU) associe a des infections invasives a pneumocoque (IIP) semble augmenter ces dernieres annees. Nous rapportons ici l’observation d’une enfant presentant un SHU suite a une pneumonie severe. Cas clinique Une enfant de 2 ans, vaccinee avec 3 doses de Prevenar 13, est hospitalisee dans un contexte de pneumonie bilaterale traitee par acide clavulanique-amoxicilline iv. Douze heures apres, elle developpe un ictere, des oedemes et une anurie. Le bilan biologique revele une anemie hemolytique, une thrombopenie, une insuffisance renale aigue, une cytolyse et une cholestase hepatique aigue. Elle beneficie d’une dialyse peritoneale et de transfusions de produits sanguins laves. Les hemocultures isolent un Streptococcus pneumoniae de sous-type 3, contenu dans le Prevenar 13. L’evolution est favorable avec normalisation de la fonction hepatique et renale 10 jours apres. Discussion Le SHU complique moins de 0,6% des IIP, essentiellement chez l’enfant de moins de 2 ans. Les complications renales sont plus frequentes et la mortalite est plus elevee (12%) que dans le SHU typique. Conclusion Cette observation met en evidence l’importance d’evoquer un SHU comme complication possible des IIP, meme chez les patients correctement vaccines.
The COVID-19 pandemic has deteriorated key determinants of health and caused major upheavals arou... more The COVID-19 pandemic has deteriorated key determinants of health and caused major upheavals around the world. Children, although less directly affected by the virus, are paying a heavy price through the indirect effects of the crisis, including poor diet, mental health impact, social isolation, addiction to screens and lack of schooling and health care, particularly among vulnerable groups. This paper is aimed at discussing the potential impact of this pandemic on children’s nutrition and lifestyle. Preliminary data from the literature and from our survey show significant disruptions in nutrition and lifestyle habits of children. While undernutrition is expected to worsen in poor countries, obesity rates could increase in middle- and high-income countries especially among precarious groups widening the gap in health and social inequalities.The real impact of the COVID-19 pandemic on children extends well beyond that of a viral infection. This crisis has public health implications t...
Ambulatory paediatric clinic in Lausanne, Switzerland, a country with a significant proportion of... more Ambulatory paediatric clinic in Lausanne, Switzerland, a country with a significant proportion of tuberculosis (TB) among immigrants. To assess the factors associated with positive tuberculin skin tests (TST) among children examined during a health check-up or during TB contact tracing, notably the influence of BCG vaccination (Bacille Calmette Guérin) and history of TB contact. A descriptive study of children who had a TST (2 Units RT23) between November 2002 and April 2004. Age, sex, history of TB contact, BCG vaccination status, country of origin and birth outside Switzerland were recorded. Of 234 children, 176 (75%) had a reaction equal to zero and 31 (13%) tested positive (>10 mm). In a linear regression model, the size of the TST varied significantly according to the history of TB contact, age, TB incidence in the country of origin and BCG vaccination status but not according to sex or birth in or outside Switzerland. In a logistic regression model including all the recorde...
Children love to play; play is their favorite occupation. They flourish through this millennial o... more Children love to play; play is their favorite occupation. They flourish through this millennial occupation. Play promotes harmonious development while integrating principles of social life. It is a solid barrier against the growing harms of sedentary lifestyle. The evolution of our societies is marked from the earliest age by a breathtaking decrease in the amount of movement and playtime of children. The consequences are known: delayed psychomotor development, psychological disorders, progression of obesity. Children of pre-carious and vulnerable families are the first victims. This review high-lights some of the essential knowledge related to the importance of play in children aged 0 to 5 years and attempts to suggest issues for recovering from a compromised situation. Solutions are individual, family and societal. The essential role of the family physician is specified.
Respiratory disease and acute respiratory difficulties are life threatening problems frequently m... more Respiratory disease and acute respiratory difficulties are life threatening problems frequently met in paediatric medicine. Since parents often call their doctor first, telephone triage is important in the correct management of children with respiratory distress. On arrival in the office or the emergency department, a child with dyspnea should rapidly be assessed for signs of severity and respiratory compromise. Oxygenation and early initiation of specific treatment are priorities in the management. Only a simple and rigorous clinical process, based on the essential, will reach all these objectives without delay. As soon as the child's situation is stabilised, the doctor decides what are the appropriate modalities for transfer. This article aims at reviewing these different issues.
Background Vasoactive drug preparation for continuous infusion in children is both complex and ti... more Background Vasoactive drug preparation for continuous infusion in children is both complex and time consuming and places the paediatric population at higher risk than adults for medication errors. We developed a mobile device application (app) as a step-by-step guide for the preparation to delivery of drugs requiring continuous infusion. The app has been previously tested during simulation-based resuscitations in a previous single-centre trial. In this trial, our aim was to assess this app in various hospital settings. Methods We did a prospective, multicentre, randomised, controlled, crossover trial to compare this app with an internationally used drug-infusion-rates table for the preparation of continuous drug infusion during standardised, simulation-based, paediatric post-cardiac arrest scenarios using a high-fidelity manikin. The scenarios were split into two study periods to assess the two preparation methods consecutively, separated by a washout distraction manoeuvre. Nurses in six paediatric emergency centres in Switzerland were randomly assigned (1:1) to start the scenario with either the app or the infusion-rates table and then complete the scenario using the other preparation method. The primary endpoint was the proportion of participants committing a medication error, which was defined as a deviation from the correct weight dose of more than 10%, miscalculation of the infusion rate, misprogramming of the infusion pump, or the inability to calculate drug dosage without calculation and guidance help from the study team. The medication error proportions observed with both preparation methods were compared by pooling both study periods, with paired data analysed using the unconditional exact McNemar test for dependent groups with a two-sided α level of 0•05. We did sensitivity analyses to investigate the carryover effect. This trial is registered with ClinicalTrials.gov, number NCT03021122. Findings From March 1 to Dec 31, 2017, we randomly assigned 128 nurses to start the scenario using the app (n=64) or the infusion-rates table (n=64). Among the 128 drug preparations associated with each of the two methods, 96 (75%, 95% CI 67-82) delivered using the infusion-rates table were associated with medication errors compared with nine (7%, 3-13) delivered using the mobile app. Medication errors were reduced by 68% (95% CI 59-76%; p<0•0001) with the app compared with the table, as was the mean time to drug preparation (difference 148•2 s [95% CI 124•2-172•1], a 45% reduction; p<0•0001) and mean time to drug delivery (168•5 s [146•1-190•8], a 40% reduction; p<0•0001). Hospital size and nurses' experience did not modify the intervention effect. We detected no carryover effect. Interpretation Critically ill children are particularly vulnerable to medication errors. A mobile app designed to help paediatric drug preparation during resuscitation with the aim to significantly reduce the occurrence of medication errors, drug preparation time, and delivery time could have the potential to change paediatric clinical practice in the area of emergency medicine.
Lactic acidosis is a common complication of status asthmaticus in adults. However, data is sparse... more Lactic acidosis is a common complication of status asthmaticus in adults. However, data is sparse in children. The aim of this study was to describe the prevalence and risk factors for lactic acidosis in children hospitalised for acute moderate or severe asthma. A total of 154 children 2–17 years of age were enrolled in a prospective observational study conducted in a tertiary hospital. All had capillary blood gas assessment 4 h after the first dose of salbutamol in hospital. The primary endpoint was the prevalence of lactic acidosis. Potential contributing factors such as age, sex, BMI, initial degree of asthma severity, type of salbutamol administration (nebuliser or inhaler), steroids, ipratropium bromide, and glucose-containing maintenance fluid represented secondary endpoints. All in all, 87% of patients had hyperlactatemia (lactate concentration > 2.2 mmol/l). Lactic acidosis (lactate concentration > 5 mmol/l and anion gap ≥ 16 mmol/l) was observed in 26%. In multivariat...
ABSTRACTBackgroundSaliva RT-PCR is an attractive alternative for the detection of SARS-CoV-2 in a... more ABSTRACTBackgroundSaliva RT-PCR is an attractive alternative for the detection of SARS-CoV-2 in adults with much less known in children.MethodsChildren and adolescents with symptoms suggestive of COVID-19 were prospectively enrolled in a comparative clinical trial of saliva and nasopharyngeal (NP) RT-PCR between November and December 2020. Detection rates and sensitivities of saliva and NP RT-PCR were compared. Participants with discordant NP and saliva RT-PCR results including viral load (VL) were also analyzed.ResultOut of 405 patients enrolled, 397 patients had two tests performed. Mean age was 12.7 years (range 1.2-17.9). Detection rates were 22.9% (95%CI 18.8-27.1%) by saliva RT-PCR, 25.4% (21.2-29.7%) by NP RT-PCR, and 26.7% (22.4-31.1%) by any test. The sensitivity of saliva was 85.2% (78.2-92.1%) when using NP as the gold standard; in contrast, when saliva was considered the gold standard, the sensitivity of NP was 94.5% (89.8-99.2%).For a NP RT-PCR VL threshold of ≥103 and ...
The name of the first author of the above mentioned published article has a double last name. The... more The name of the first author of the above mentioned published article has a double last name. The family name should have been "Ruman-Colombier" instead of "Ruman". The original article has been corrected. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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