Christèle Gras-Le Guen

Centre Hospitalier Universitaire de Nantes | CHU Nantes · Pediatrics

The French “OMIN registry” was established in 2015 to collect nationwide standardised data concerning biological, clinical, environmental and social characteristics of sudden unexpected death in infancy (SUDI) and unexpected death in children aged 1–2 years. A biobank has existed since July 2020 to store biological samples for each case. This artic...

Objective: To describe pre-COVID-19 pandemic current practices in virological investigations, including type, frequency of samplings, and documented viruses, in sudden unexpected death in infancy (SUDI) and to compare results according to the cause of death. Study design: Between May 2015 and December 2019, infants under 2 years of age included...

Background: To evaluate the association between exposure to early skin-to-skin contact (SSC) and incidence of late-onset sepsis (LOS) in extremely and very preterm infants. Methods: Observational study using the national population-based EPIPAGE-2 cohort in 2011. A propensity score for SSC exposure was used to match infants with and without expo...

Objective In the context of vaccine scepticism, our study aimed to analyse the association between immunization status and the occurrence of sudden unexpected death in infancy (SUDI). Study design: A multi-centre case–control study was conducted between May 2015 and June 2017 with data from the French national SUDI registry (OMIN) for 35 French reg...

Importance: Assessment of the quality of initial care is necessary to target priority actions that can reduce the still high morbidity and mortality due to community-onset severe bacterial infections (COSBIs) among children. Objective: To study the prevalence, characteristics, and determinants of suboptimal care in the initial management of COSB...

Objective: In the context of vaccine scepticism, our study aimed to analyse the association between immunization status and the occurrence of sudden unexpected death in infancy (SUDI). Study design: A multi-centre case–control study was conducted between May 2015 and April 2017 with data from the French national SUDI registry (OMIN) for 37 French...

Objective Ogival palate (i.e., a narrow and high-arched palate) is usually described in obstructive breath disorder but has been found in infants unexpectedly deceased. We studied the association between ogival palate and sudden unexpected death in infancy (SUDI) on the basis of a computed tomography (CT) evaluation. Methods We conducted a monocen...

Non-pharmaceutical interventions (NPIs) against coronavirus disease 2019 were implemented in March 2020. These measures were followed by a major impact on viral and non-viral diseases. We aimed to assess the impact of NPI implementation in France on hospitalized community-acquired pneumonia (hCAP) frequency and the clinical and biological character...

Importance The highly variable practices observed regarding the early detection and diagnostic workup of suspected child physical abuse contribute to suboptimal care and could be partially related to discrepancies in clinical guidelines. Objective To systematically evaluate the completeness, clarity, and consistency of guidelines for child physica...

Introduction Heart failure (HF) in children is a severe condition which diagnosis can be difficult [1], [2]. Aims We aimed at describing the incidence and outcome of new-onset HF with no know heart disease in the Loire-Atlantique area. Methods We conducted a retrospective monocentric observational study between 2007 and 2016. We included all chil...

Introduction Bronchiolitis is the leading cause of hospitalization for infants but its economic burden is not well documented. Our objective was to describe the clinical evolution and to assess the 1-month cost of a first episode of acute bronchiolitis presenting to the emergency department (ED). Methods Our study was an epidemiologic analysis and...

Background Children are underrepresented in the COVID-19 pandemic and often experience milder disease than adolescents and adults. Reduced severity is possibly due to recent and more frequent seasonal human coronaviruses (HCoV) infections. We assessed the seroprevalence of SARS-CoV-2 and seasonal HCoV specific antibodies in a large cohort in north-...

Background: Infectious diseases are still an important cause of morbidity and mortality in high-income countries and may preferentially affect predisposed children, especially immunocompromised children. We aimed to evaluate the frequency of recommended immunological tests in children with community-onset severe bacterial infection (COSBI) admitte...

Background Heart failure (HF) in children is a severe condition which diagnosis can be difficult. Time from first symptoms to diagnosis, called time to diagnosis (TTD) is related to prognosis in several diseases. Purpose The aim of this study was to measure TTD in children with new-onset HF and assess its consequences and determinants. The pediatr...

Objectives To evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children. Methods A before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to...

Objectives: To systematically assess the extent to which bone scintigraphy (BS) could improve the detection rate of skeletal injury in children suspected of physical abuse with an initial negative radiological skeletal survey (RSS). Study design: We searched MEDLINE and Web of Science for series of ≥20 children suspected of physical abuse who un...

Background: Timely diagnosis of child physical abuse is of paramount importance. The added value of bone scintigraphy (BS) after a negative radiological skeletal survey (RSS) in children with suspected physical abuse has never been evaluated. Objective: The objective of this study was to assess the extent to which BS could improve the detection rat...

Objective to study recent epidemiological trends of sudden unexpected death in infancy (SUDI) in Western Europe. Study design Annual national statistics of death causes for 14 Western European countries from 2005 to 2015 were analyzed. SUDI cases were defined as infants younger than one year with the underlying cause of death classified as “sudden...

Résumé Les infections liées à l'herpès virus humain (HSV), au virus de la varicelle et du zona (VZV) et au virus de la grippe (Influenza A et B) sont très fréquentes en pédiatrie et sont le plus souvent bénignes avec une guérison spontanée. L'utilisation des antiviraux antigrippaux (inhibiteurs de neuraminidase) a été étudiée dans de larges essais...

Aim We assessed the diagnostic accuracy of serum (1→3)‐β‐D‐glucan (BDG) for neonatal invasive candidiasis (NIC) using the recommended cut‐off usually used in adults for detecting invasive candidiasis and searched for an optimal cut‐off for ruling out NIC. Methods We conducted a prospective cross‐sectional study in Nantes University medical centre...

Objectives: To describe the epidemiology of community-onset severe bacterial infections in children and its recent evolution. Design: Prospective, observational, population-based study from 2009 to 2014. Setting: An administrative area accounting for 13% of the French pediatric population. Patients: All children 1 month to 16 years old who d...

Corticosteroids (CS) are standard therapy for the treatment of Duchenne's muscular dystrophy (DMD). Even though they decrease inflammation, they have limited efficacy and are associated with significant side effects. There is therefore the need for new protolerogenic treatments to replace CS. Dystrophin-deficient rats (Dmdmdx) closely resemble the...

Objective: To investigate a temporal association between vaccination and subdural hematoma, the main feature of abusive head trauma. Study design: From a prospective population-based survey carried out in 1 administrative district in France between January 2015 and April 2017, including all infants between 11 and 52 weeks old who underwent a fir...

Immunological characterization of a rat model of Duchenne’s disease and demonstration of improved muscle strength after anti-CD45RC antibody treatment

Duchenne muscular dystrophy (DMD) has as standard pharmacological therapy with corticoisteroids (CS) that decrease inflammation and immune responses present in patients and animal models. CS have however limited efficacy and important and numerous side effects. Therefore, there is a need for new anti-inflammatory and pro-tolerogenic treatments that...

Background In a context of suboptimal vaccination coverage and increasing vaccine hesitancy, we aimed to study morbidity and mortality in children related to missing or incomplete meningococcal C and pneumococcal conjugate vaccines. Methods We conducted a prospective, observational, population‐based study from 2009 to 2014 in a French administrati...

Introduction L’implémentation des vaccins pneumococcique conjugué et méningococcique a transformé l’épidémiologie des infections bactériennes sévères (IBS) communautaires de l’enfant dans les pays avec une économie avancée. Dans un contexte national de forte hésitation vaccinale et de faibles taux de couverture vaccinale, notre objectif était d’étu...

Introduction La couverture vaccinale est insuffisante en France, exposant au risque de réapparition des maladies. La méfiance envers les vaccins est en augmentation et met en difficulté les médecins généralistes. Ceux-ci sont dans l’ensemble favorables à la vaccination mais expriment un besoin de formation sur le sujet. L’e-learning est un outil ré...

Aim: This study evaluated the epidemiology and performance of biomarkers for identifying bacterial infections in children who presented with fever without source. Methods: We conducted a prospective cohort study in the paediatric department at the University Hospital of Nantes, France, in 2016. Children older than six days and younger than five...

Surgical site infections are the leading cause of perioperative morbidity and mortality as well as increased costs following surgery. Among preventive measures, antibiotic prophylaxis, when indicated, significantly decreases these risks. Adult and pediatric guidelines have recently been published (1,2). Specific pediatric data are scarce, but adult...

Bacterial skin and soft tissues infections are common in children and frequently do not require systemic antibiotics, especially if lesions are superficial. Careful washing is always indicated in superficial lesions and is often sufficient. Careful evaluation of symptoms (which may be difficult despite the accessibility of the lesions) should be pe...

Rational use of antibiotic has become a national and international health priority to fight against the emergence of multiresistant bacteria. Neonates are particularly exposed to antibiotic treatments because of their high susceptibility to severe infection and the lack of specificity of sepsis signs that make diagnosis difficult. This population i...

Background: Minor head traumatisms are a common reason for consultation in paediatric emergency departments. The diagnosis of traumatic brain injuries involves performing a cranial computed tomography (CCT), associated with a risk of cancer due to the radiation. The serum S100B is an effective biomarker used to reduce reliance on CCT. While refere...

Background: Many countries have observed an early and strong impact of implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) on community-acquired pneumonia (CAP). High levels of C-reactive protein (CRP) and procalcitonin (PCT) are considered biomarkers of bacterial infection (particularly infection due to pneumococcus); therefore...

Background: Adolescent vaccination coverage tends to be suboptimal, leading to resurgent infectious pathologies and vulnerability to various pathogens. The low frequency of medical consultations and missed opportunities for vaccination are often used to explain the low rate of vaccination. The aim of this study was to assess if the vaccination cov...

The objective of this study was to investigate whether acute pain in abused children was under recognized by doctors and nurses compared to children evaluated for accidental injuries. We hypothesize that an abused child’s reaction to physical pain could be an additional symptom of this challenging diagnosis. For the observational prospective case c...

Background and objectives: In developed countries, where omphalitis has become rare and related mortality nil, benefits of antiseptic use in umbilical cord care have not been demonstrated. We aimed to assess the noninferiority of dry care compared with antiseptics in France where antiseptic use is widespread. Methods: We conducted a noninferiori...

The concept of damage control in pediatrics: everything a physician needs to know in practice. After the terrorist attacks in France and the rest of the world, children may be potential targets and be part of the victims. In order to prepare for these situations of «war medicine» our medical training is inadequate. It seems important to draw attent...

Introduction Le virus respiratoire syncytial (VRS) est l’agent le plus fréquent d’infections respiratoires aiguës basses (IRAB) de l’enfant avec des formes cliniques variant d’un simple rhume à une bronchiolite ou une pneumonie sévère. L’objectif de cette étude est d’analyser les caractéristiques des IRAB de l’enfant au cours des périodes de circul...

Background Lower respiratory tract infection is a common cause of consultation and antibiotic prescription in paediatric practice. The misuse of antibiotics is a major cause of the emergence of multidrug-resistant bacteria. The aim of this study was to evaluate the frequency, changes over time, and determinants of non-compliance with antibiotic pre...

Background: To date, the Pediatric Emergency Care Applied Research Network (PECARN) rule for identifying children who are at very low risk of clinically-important traumatic brain injuries after minor head trauma has not been validated prospectively in an independent population. Our goal was to evaluate the diagnostic performance of the PECARN clin...

Objectives The Sudoscan™ system (Impeto Medical, Paris, France) has been recently proposed as a standardized, easy, painless tool for sudomotor function assessment. It is now used as an additional diagnostic tool in small fibre neuropathy. So far, no work has been published in children. The aim of this study was to measure electrochemical skin cond...

Misuse of antibiotics is largely responsible for the emergence of bacterial resistance. Children represent a subset of the population who frequently receive antibiotics. The objectives were to calculate the frequency of antibiotic prescriptions that do not comply with best practice recommendations in paediatrics primary care and to examine the thou...

We wanted to determine the diagnostic performance of a rapid influenza diagnostic test (RIDT) used bedside in a pediatric emergency department (PED). This was a prospective study over four consecutive winters (2009-2013), comparing the results of a RIDT (QuickVue®) with RT-PCR in children admitted to a PED. Among the 764 children included, we did n...

Objective: To analyse tools used to critically appraise primary studies included in systematic reviews (SRs) of time to diagnosis (TTD). Study design and setting: We systematically searched MEDLINE via PubMed and Web of Science for SRs of TTD published up to the end of February 2015; we identified and characterised tools used for critical apprai...

Diagnostic of early neonatal infection remains a serious challenge. Since clinical symptoms and biological markers are neither sensitive nor specific, a lot of newborns suspected of infection, undergo biological analysis and empirical antibiotic treatment awaiting bacteriological results. However, the prevalence of the disease has dramatically decr...

Importance The procalcitonin (PCT) assay is an accurate screening test for identifying invasive bacterial infection (IBI); however, data on the PCT assay in very young infants are insufficient.Objective To assess the diagnostic characteristics of the PCT assay for detecting serious bacterial infection (SBI) and IBI in febrile infants aged 7 to 91...

The pediatric population displays its own pharmacological characteristics, making children vulnerable to adverse drug reactions (ADRs). To determine the incidence of ADRs among the pediatric emergency department (PED) population. This is a descriptive, noncontrolled, prospective, and single-center study, during 4 consecutive months in the PED of Na...

Fever in children is a very common symptom associated most of the time with a viral infection. However, in 7% of children, fever without source is the first symptom of a serious bacterial infection such as pneumonia, meningitis, pyelonephritis or bacteremia. The key point in clinical examination of these children is the early identification of toxi...

The first weeks of life are a period of great immaturity and vulnerability. While pathologies and their semiology are very specific in this period, doctors must quickly identify therapeutic emergencies but also reassure parents when symptoms are physiological for age. Jaundice, baby crying, fever or breastfeeding constitute various medical challeng...

Gastroenteritis is a public health problem. Every practitioner must know the dehydration signs. The only effective treatment is the rehydration solution. The main differential diagnosis is hemolytic-uremic syndrome. Another cause has to be searched in front of isolated vomiting.

The number of children admitted to paediatric emergencies is increasing steadily, and is responsible for an altered quality in the patients' reception and some major perturbations in the care organization. In this context, the primary care physicians play a major role in explaining their patients "how to use" the paediatric emergency department (pr...

Child abuse is a major public health problem. The consequences including death, but also physical injuries and psychological troubles. To know and recognize the possibility of child abuse is essential for all doctors. This diagnostic hypothesis must be considered alongside all pathologies in varied clinical presentations. The practitioner must keep...

Many cases of measles in adults were notified during the epidemic in France in 2008. Studying these cases can lead to a better understanding of their potential complications, little data having been reported on renal dysfunction during measles. A retrospective study of biologically confirmed measles cases in patients hospitalized for more than 24ho...

Vancomycin is the usual antibiotic treatment in coagulase-negative staphylococcus sepsis in premature infants but causes renal toxicity. As linezolid is effective in Gram-positive cocci infection, and devoid of renal side-effects, it has been used in Nantes neonatal intensive care units and linezolid plasma concentrations were monitored. The aims o...

The microbiote constitute a complex ecosystem. Its establishment in the first weeks of the life seems to constitute a critical period of g"programmingg" of the immune system. Any disturbance in the initial process of colonization by the microbiote could impact long-term health and be implicated in several pathologies as obesity, diabetes, inflammat...

The regular exceeding of the capacities of paediatric emergency departments in periods of epidemics disrupts the organisation of the management of seriously ill children and compromises the quality of the reception given to these children and their families. This recurring phenomenon raises the need for an analysis of the determining factors in ord...

Introduction Suboptimal care is frequent in the management of severe bacterial infection. We aimed to evaluate the consequences of suboptimal care in the early management of severe bacterial infection in children and study the determinants. Methods A previously reported population-based confidential enquiry included all children (3 months- 16 year...

Unlabelled: Late-onset infection is known to increase the risk of neurodevelopmental impairment in infants born extremely preterm. However, little data is available regarding infants born moderately preterm. The aim of this study was to determine whether late-onset infection in moderately preterm infants (<35 weeks of gestation) was associated wit...

Background: Pneumococcal serotypes 1, 3, 5, 7F, and 19A were the most implicated in community-acquired pneumonia (CAP) after implementation of 7-valent pneumococcal conjugate vaccine (PCV7). In France, the switch from PCV7 to 13-valent pneumococcal conjugate vaccine (PCV13) occurred in June 2010. An active surveillance network was set up to analyz...

Diagnostic of early-onset neonatal infection (EONI) remains an emergency. Recent studies underline the potential benefit of using Procalcitonin (PCT) in early diagnosis of bacterial infections in neonates. The aim of this study was to evaluate the diagnostic value of an umbilical blood cord PCT based algorithm in newborns suspected of EONI. The dia...

Because clinical symptoms and biological markers are neither sensitive nor specific, newborns are frequently suspected of having an infection. In France, 30-50% of newborns are suspected of having early-onset sepsis (EOS) and many of them undergo laboratory tests and empirical antibiotic treatments while awaiting results. The aim of this study was...

Background Because clinical symptoms and biological markers are neither sensitive nor specific, newborns are frequently suspected of having an infection. In France, 30–50% of newborns are suspected of having early-onset sepsis (EOS) and many of them undergo laboratory tests and empirical antibiotic treatments while awaiting results. The aim of this...

While our European and North American colleagues have recently updated their recommendations, the 2000 Consensus Conference remains the main guideline on management of acute viral bronchiolitis in France. We aimed to establish an updated inter-regional protocol on management of acute viral bronchiolitis in infants. Pediatricians, pediatric pulmonol...

Surgical antibiotic prophylaxis has demonstrated its effectiveness in reducing surgical site infections. Existing recommendations for adults are however subject to poor compliance. Surgical antibiotic representing a significant proportion of antibiotic prescriptions, it is then important to respect its general principles (narrow spectrum, short dur...

The pediatric osteo-articular surgery has certain characteristics that justify specific recommendations (spine surgery, reconstruction after tumorectomy). The children with the higher risks of surgical site infection are children with comorbidities or undergoing prolonged surgery. Bacteria targeted by antibioprophylaxis are those of the skin flora,...

Neonatal surgical antibioprophylaxis must take into account the specificities of this life period, as immunological immaturity, microbiotal implantation and antibiotic treatment pharmacokinetics properties. Very few data are available, but it seems that coagulase negative Staphylococcus (CNS) is the most reported bacteria, in intestinal tract at th...

The Haute autorité de santé released clinical practice guidelines in 2000 to assist in the management of bronchiolitis. These guidelines emphasized supportive care with nasal suctioning and encouraged chest physiotherapy. The aim of this study was to examine the adherence to the french guidelines for the management of bronchiolitis by general pract...