Lenval Foundation

BackgroundNew technologies for the management of children with type 1 diabete (T1D) are constantly and rapidly evolving. However, few real-life studies have been conducted, and rarely in the youngest patients (<6 years). AimTo study parental satisfaction with continuous and flash glucose monitoring devices in young children with T1D. MethodsA questionnaire was completed by the parents of 114 children under the age of 6 years with T1D treated with an insulin pump followed-up in one of the hospitals of the French ADIM network between January and July 2020. ResultsOne hundred and nine patients (96 %) were equipped with a glucose monitor and 95 % (104/109) of parents stated that they were satisfied or very satisfied with their child's monitoring device, with no significant difference in satisfaction rates between flash and continuous glucose monitoring. The parameter most strongly associated with satisfaction was confidence in the reliability of the device (p = 0.008). Parents who struggled to apply the device were significantly less satisfied (p = 0.024). In real-life use, 83 % of parents (90/109) used additional adhesives, 28 % reported mild skin reactions (30/108) and 39 % severe skin reactions (42/108), 50 % stated that applying the device was not painful, and 95 % found the device easy to apply. The most commonly reported unexpected difficulties were device malfunction (by 16 respondents), the device being too large and causing scarring (6 respondents), and lengthy calibration (6 respondents). ConclusionThe vast majority of parents in this group of young children with T1D were satisfied with continuous or flash glucose monitoring. Satisfaction was strongly associated with confidence in the reliability of the device. Reported adverse effects such as skin reaction and difficulties attaching the device highlight the importance of data on real-life use.

<b>Context:</b> Apnea in term newborns affects one in 1000 newborns in the US. In spite of this significant prevalence, the condition remains little studied. A pilot study carried out in our center, including 33 full-term newborns presenting with sleep apnea syndrome (SAS), reported that 33% were idiopathic. The objective of this study was thus to determine the epidemiological, clinical and paraclinical characteristics of idiopathic apnea in newborns and infants under 6 months of age, born at term. <b>Methodology:</b> We conducted a national, observational, retrospective, multicenter study, collecting the different cases of idiopathic apnea in newborns and infants less than 6 months, born at term between 2014 and 2021 as retrieved from the French Reference Centers for rare pediatric lung diseases. Idiopathic apnea was defined by abnormal polysomnography, with an apnea hypopnea index (AHI) ≥ 1/h, and with no observed etiology except GERD. <b>Result:</b> 46 newborns and infants younger than 6 months were included at 6 centers. The median (interquartile range [IQR]) age of onset of symptoms was 10 [7;25] days. Cyanosis and hypotonia were the two most described symptoms. These SASs had the following polysomnographic characteristics: a median AHI of 19.4/h [8.27;32.9], a median obstructive apnea index (OAI) of 0.1/h [0;2.7], and a median central apnea index (CAI) of 6.3/h [1.9;12.8].Evolution was favorable in all cases, with regression of the symptomatology and normalization of the AHI at 4 months. <b>Conclusion:</b> Idiopathic apneas, mostly central SAS, showed a consistantly favorable evolution. A definition of pathological and severe AHI, CAI and OAI thresholds adapted to this age group would, however, seem necessary.

BackgroundDevelopmental dyslexia, a specific and long-lasting learning disorder that prevents children from becoming efficient and fluent readers, has a severe impact on academic learning and behavior and may compromise professional and social development. Most remediation studies are based on the explicit or implicit assumption that dyslexia results from a single cause related to either impaired phonological or visual-attentional processing or impaired cross-modal integration. Yet, recent studies show that dyslexia is multifactorial and that many dyslexics have underlying deficits in several domains. The originality of the current study is to test a remediation approach that trains skills in all three domains using different training methods that are tailored to an individual’s cognitive profile as part of a longitudinal intervention study.MethodsThis multicenter randomized crossover study will be conducted in three phases and will involve 120 dyslexic children between the ages of 8 and 13 years. The first phase serves as within-subject baseline period that lasts for 2 months. In this phase, all children undergo weekly speech-language therapy sessions without additional training at home (business-as-usual). During the second phase, all dyslexics receive three types of intensive interventions that last 2 month each: Phonological, visual-attentional, and cross-modal. The order of the first two interventions (phonological and visual-attentional) is swapped in two randomly assigned groups of 60 dyslexics each. This allows one to test the efficacy and additivity of each intervention (against baseline) and find out whether the order of delivery matters. During the third phase, the follow-up period, the intensive interventions are stopped, and all dyslexics will be tested after 2 months. Implementation fidelity will be assessed from the user data of the computerized intervention program and an “intention-to-treat” analysis will be performed on the children who quit the trial before the end.DiscussionThe main objective of this study is to assess whether the three types of intensive intervention (phase 2) improve reading skills compared to baseline (i.e., non-intensive intervention, phase 1). The secondary objectives are to evaluate the effectiveness of each intervention and to test the effects of order of delivery on reading intervention outcomes. Reading comprehension, spelling performance and reading disorder impact of dyslexic readers are assessed immediately before and after the multimodal intervention and 2 months post-intervention.Trial registrationClinicalTrials.gov, NCT04028310. Registered on July 18, 2019.

(1) Background: Cerebral palsy (CP) is associated with a higher incidence of epileptic seizures. This study uses a prediction model to identify the factors associated with epilepsy in children with CP. (2) Methods: This is a retrospective longitudinal study of the clinical characteristics of 102 children with CP. In the study, there were 58 males and 44 females, 65 inpatients and 37 outpatients, 72 had epilepsy, and 22 had intractable epilepsy. The mean age was 16.6 ± 1.2 years, and the age range for this study was 12-18 years. Data were collected on the CP etiology, diagnosis, type of epilepsy and spasticity, clinical history, communication abilities, behaviors, intellectual disability, motor function, and feeding abilities from 2005 to 2020. A prediction model, Epi-PredictMed, was implemented to forecast the factors associated with epilepsy. We used the guidelines of "Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis" (TRIPOD). (3) Results: CP etiology [(prenatal &gt; perinatal &gt; postnatal causes) p = 0.036], scoliosis (p = 0.048), communication (p = 0.018), feeding disorders (p = 0.002), poor motor function (p &lt; 0.001), intellectual disabilities (p = 0.007), and the type of spasticity [(quadriplegia/triplegia &gt; diplegia &gt; hemiplegia), p = 0.002)] were associated with having epilepsy. The model scored an average of 82% for accuracy, sensitivity, and specificity. (4) Conclusion: Prenatal CP etiology, spasticity, scoliosis, severe intellectual disabilities, poor motor skills, and communication and feeding disorders were associated with epilepsy in children with CP. To implement preventive and/or management measures, caregivers and families of children with CP and epilepsy should be aware of the likelihood that these children will develop these conditions.

Abstract Background The mass terrorist attack in Nice, France, in July 2016 caused deaths and injuries in a local population, including children and adolescents. The Nice Pediatric Psychotrauma Center (NPPC) was opened to provide mental health care to the pediatric population (0–18 years) who experienced traumatic events. Objectives To report clinical findings and provide considerations focusing on 1) Traumatic events; 2) Psychiatric diagnoses; 3) Needed care of pediatric population; 4) Recommendations based on the experience of NPPC Methods In this retrospective study, we conducted quantitative and qualitative data collection and analysis of new and follow-up consultations, primary and comorbid diagnoses, and the kind of trauma (terrorist attack versus other kinds of trauma). Ethics approval was obtained from the local Ethics committee. Results 866 children and adolescents were followed in the NPPC. A high number of children and adolescents impacted by the terrorist attack required follow-up consultations (average of 30 consultations per week). After exposure to the mass terrorist attack, the first care-seeking requests continued to occur three years later, although at a slower rate than in the first and second years. New consultations for other kinds of trauma were observed over time. We found a high rate of Post-Traumatic Stress Disorder (PTSD; 71%) in this population with a high rate of comorbidities (67%), mainly sleep disorders (34.7%) and mood and anxiety disorders (16.2%). Discussion This study supports previous findings on the significant impact of mass trauma in the pediatric population showing even a higher level of PTSD and a high rate of comorbidities. This may be explained by the brutality of the traumatic event, particularly for this age group. The findings of this study have implications for early interventions and long-term care for children and adolescents to prevent the development of chronic PTSD into adulthood.

Background: The results of 12 h nighttime Cheneau–Toulouse–Munster (CTM) brace wear on adolescent idiopathic scoliosis are poorly described. Objective: The main objective was to analyze the efficiency of 12 h nighttime CTM brace wear on adolescent idiopathic scoliosis. The secondary objective was to identify the factors influencing good results. Methods: One hundred and fifty consecutive patients treated between 2006 and 2017 were retrospectively analyzed with subgroup analysis for the main curve pattern (main thoracic or main lumbar). The inclusion criteria were evolutive scoliosis, 12 h nighttime CTM brace wear, Risser stages 0-1-2 at the time of the prescription, and Cobb angle below 45 degrees. Success was defined as no surgery, and the main curve Cobb angle (CA) progression ≤5°. The overcurve was defined as the proximal thoracic curve above the main thoracic and mid-thoracic above the main lumbar curves. A logistic regression model was built to assess the predictors of success. RESULTS: Overall success was 70%: 60% for main thoracic (MT) and 84% for main lumbar scoliosis (ML) (p = 0.003). Efficacy was 62% at Risser stage 0 and 78% at Risser stage 1–2 (p = 0.054). For MT, failure was associated with high in-brace sagittal C7 tilt (Odds Ratio = 0.72, p = 0.014) and low initial overcurve CA (Odds Ratio = 0.42, p = 0.044). For ML, a high standing height was associated with success (OR = 1.42, p = 0.035), and frontal unbalanced C7 tilt was associated with failure (OR = 0.43, p = 0.02). Conclusion: Twelve-hour nighttime CTM brace wear provided good results for main lumbar curves with balanced frontal C7 tilt. For MT, this treatment is indicated if the in-brace sagittal C7 tilt is well balanced from Risser stage 2.