Publications by authors named "Karine Levieux"

Objective: To study the impact of nonpharmaceutical interventions implemented during the COVID-19 pandemic on the monthly incidence of sudden unexpected death in infancy (SUDI) cases overall and those with a viral or bacterial identification.

Study Design: We conducted an interrupted time-series analysis using seasonally adjusted Poisson regression models from the French national prospective and multicenter SUDI registry, that included all SUDI cases below the age of 1 year who died from 2016 to 2021 in mainland France.

Results: Of 998 SUDI cases analyzed, 750 were recorded during the prepandemic period (January 2016 through March 2020) and 248 during the NPI period (April 2020 through December 2021).

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Unlabelled: 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 article aimed to detail (1) a brief history and the objectives of the registry; (2) a description of the methodology used; (3) the first results of the registry, i.

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Article Synopsis
  • In September 2023, France launched a national immunization campaign using nirsevimab, a monoclonal antibody targeting respiratory syncytial virus (RSV).
  • A case-control study was conducted with 288 infants from 20 pediatric intensive care units (PICUs) to assess the effectiveness of nirsevimab against severe RSV bronchiolitis.
  • The study found nirsevimab to have an effectiveness of 75.9% in the main analysis, with higher estimates of 80.6% and 80.4% in sensitivity analyses, confirming its efficacy observed in previous clinical trials.
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Background: Prematurity is one of the risk factors for sudden unexpected infant death (SUID), a phenomenon that remains poorly explained.

Materials And Methods: The analysis of specific factors associated with SUID among very premature infants (VPI) was performed through a retrospective review of data collected in the French SUID registry from May 2015 to December 2018. The factors associated with SUID among VPI were compared with those observed among full-term infants (FTI).

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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 in the French SUDI registry were classified in one of 4 groups by causes of death according to the classification by Goldstein et al. : unexplained (SIDS), infectious, explained but noninfectious, and undetermined.

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Article Synopsis
  • The study investigated the link between vaccination status and sudden unexpected death in infancy (SUDI) amid vaccine skepticism, using data from a multi-center case-control analysis in France.
  • Researchers compared immunization status of 91 infants who died from SUDI with 182 matched controls, finding that 22% of SUDI cases were non-immunized versus 12% of controls.
  • The study concluded that being non-immunized for several vaccines is associated with a higher risk of SUDI, highlighting the importance of addressing vaccine hesitancy for public health.
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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.

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Article Synopsis
  • Non-pharmaceutical interventions (NPIs) against COVID-19, implemented in March 2020, resulted in a significant reduction in hospitalized community-acquired pneumonia (hCAP) cases in children in France.
  • A detailed analysis of 2,972 hCAP cases revealed a 63% drop in monthly cases after NPIs began, with a notable increase in the median age of affected children.
  • The study also found that fewer children had high inflammatory markers and there was a trend towards a decrease in pleural effusion cases during the NPI period, suggesting changes in the pathogens causing hCAP.
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  • Blood cultures in children with community-acquired pneumonia (CAP) often yield negative results, prompting the study of various biomarkers to predict the presence of bacteremia.
  • A study of 13,752 children found that while blood culture was positive in only 3.6% of cases, levels of absolute neutrophils count (ANC), C-reactive protein (CRP), and procalcitonin (PCT) were significantly higher in those with bacteremia.
  • Of the biomarkers tested, PCT was the most reliable for predicting bacteremia, outperforming white blood cell counts, and CRP stood out as the best routinely available biomarker for this condition.
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  • Sudden unexpected infant death (SUID) is a major cause of infant mortality, and thorough toxicology studies are recommended in investigations.
  • A study of the French national SUID registry analyzed 624 cases, revealing that 9% of infants tested positive for toxic substances, primarily from expected and unexpected sources like opioids and cannabis.
  • Infants with unexpected toxins displayed distinct risk factors, such as unsafe sleeping positions, younger maternal age, and higher rates of maternal drug abuse, highlighting the importance of routine toxicology testing in these cases.
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Objective: To study recent epidemiologic 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 1 year with the underlying cause of death classified as "sudden infant death syndrome," "unknown/unattended/unspecified cause," or "accidental threats to breathing.

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Importance: In several countries, 5 years after 13-valent pneumococcal conjugate vaccine (PCV13) implementation, serotype replacement has been reported for invasive pneumococcal disease, which raises concerns about the long-term outcome of PCV13 implementation. The long-term effect of vaccination on community-acquired pneumonia (CAP) remains unknown.

Objective: To assess the long-term outcome of PCV13 implementation on CAP in children.

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We describe here changes in the bacterial causes of pleural empyema before and after implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) program in France (2009-2017). For 220 (39.3%) of 560 children, a bacterial cause was found.

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Introduction: Even after 'back-to-sleep' campaigns, sudden unexpected infant death (SUID) continues to be the leading cause of death for infants 1 month to 1 year old in developed countries, with devastating social, psychological and legal implications for families. To sustainably tackle this problem and decrease the number of SUIDs, a French SUID registry was initiated in 2015 to (1) inform prevention with standardised data, (2) understand the mechanisms leading to SUID and the contribution of the already known or newly suggested risk factors and (3) gather a multidisciplinary group of experts to coordinate and develop innovative and urgent research in the SUID area.

Methods And Analysis: This observational multisite prospective observatory includes all cases of sudden unexpected deaths in children younger than 2 years occurring in the French territory covered by the 35 participating French referral centres.

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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, PCV13 implementation should have different effectiveness on CAP depending on the levels of these two biomarkers. To demonstrate this assumption, we analyzed the evolution of number of CAP cases seen in pediatric emergency departments in France after PCV13 implementation (in 2010) by levels of these two biomarkers.

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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 control study in an emergency department, children were eligible when: younger than six years old, the reported trauma occurred within the previous seven days, the trauma comprised a bone injury or burn, and the child was able to express his or her pain.

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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.

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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 prescription recommendations for children admitted in paediatric emergency department (PED) with community-acquired pneumonia (CAP).

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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 thoughts and feelings of physicians and parents about antibiotic prescription and recommendations from the national health authorities.

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Minor head trauma is a common reason for consultation in pediatric emergency departments. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) published a clinical decision rule for its management. It aimed to help clinicians identify children with a very low risk of developing intracranial lesions, so that unnecessary cranial computed tomography (CCT) scan radiation could be avoided, as such exposure is associated with a rising risk of cancer in this young population.

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The management of children dyspnea depends on the severity and symptomatology. The severity assessment requires knowledge of the standards of respiratory rate by age and signs of failure ventilatory mechanics. Recognize the time of dyspnea is important because it guides the diagnosis.

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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 (priority in case of vital emergency, periods with lot of admissions and increased waiting time ..

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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 order to find ways to improve the system and anticipate this period of the year which constitutes a real challenge for nursing teams.

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