Studies on growth response to medical interventions in children with growth delay are mainly randomized controlled trials (RCTs) and observational studies. RCTs establish cause-effect relationships under controlled conditions but limited generalizability to real-life. Conversely, observational studies reflect real-life conditions but are subject to confounding factors and bias. Data regarding catch-up growth and associated factors in children who do not benefit from medical treatment are lacking. To evaluate the causal impact of etiological treatment (ET) versus a wait-and-see approach (WS) on one-year catch-up growth in children with growth delay of different etiologies and to identify factors associated with good catch-up growth independent of the intervention. Retrospective cohort of children referred for growth delay, defined by height < -2 SD, height < -2 SD from target height, or growth velocity < 0 SD. Causal inference methods, including inverse probability treatment weighting (IPTW), and weighted Poisson regression with robust variance, were used to estimate the average treatment effect in the treated and relative risk, respectively. A variable selection procedure was applied using backward selection by Akaike Information Criterion. We included 198 children: 100 with ET and 98 with WS. Main diagnosis was secondary growth failure (42.4 %). Good catch-up growth was more frequent with ET versus WS (31.31% vs. 3.54 %, p < 0.05). Patients in the ET group had a 10.3 times higher chance of achieving one-year good catch-up growth. Young age and low growth velocity at baseline were associated with better catch-up growth, independently of the intervention. ET significantly improves growth catch-up in children with growth delay. Young age and low growth velocity are associated with good catch-up growth, regardless of intervention. The use of IPTW strengthen the validity of the findings in a real-world setting, despite the retrospective study design. This approach highlights the effectiveness of interventions and the robustness of findings through advanced statistical adjustments.

IntroductionThe primary objective of this study is to describe the refractive needs of vulnerable children according to their social security status. The secondary objective of this study is to describe the types of ametropia in this population of children with limited access to ocular health care. MethodsChildren with limited access to ocular health care were recruited. Their social security status was assessed as well as their need for optical correction. Children received an orthoptic and ophthalmological examination. The ametropia thresholds requiring optical correction were defined as follows: hyperopia if spherical equivalent (SE) ≥ 3D before 6 years, ≥ 2.25 D between 6 and 12 years, ≥ 1.5 D from 12 years onwards; myopia if SE ≤ 0.5 D; astigmatism if cylinder C ≥ 1D; anisometropia if sphere difference between both eyes ≥ 1D. ResultsOut of 83 planned patients, 60 children turned up. 51 files for children aged 1 to 14 years old were analysed. 63.2% of children without social security required an optical correction, compared with 65.6% of children receiving State Medical Aid (SMA) and 66.7% of children receiving Universal Health Protection (UHP). Out of 102 eyes, SE was hypermetropic in 56.9% of cases, myopic in 21.6% of cases; astigmatism was present in 60.8% of cases. Anisometropia was assessed in 27.5% of cases. 33 children out of 51 (64.7%) required correction with glasses. Discussion and ConclusionChildren benefiting from SMA or UHP have similar refractive needs than children without social security, and probably greater than those of the general population. In our population there is two-thirds of patients with ametropia requiring optical correction; most of these children did not initially wear glasses, which suggests that access to ophthalmic and optical care is more difficult for vulnerable children.

BackgroundUnnecessary dietary eliminations may impair quality of life, affect children's growth, and negatively impact healthcare costs. Previous studies reported that around 11 % to 28 % of children continue a food-avoidance diet despite a negative oral food challenge (OFC). ObjectivesThis study aimed to evaluate the actual consumption at home of the tested food after a negative OFC and the reasons reported by families in the case of persistent avoidance. Methods and settingsA retrospective study was conducted in the Pediatric Gastro-Enterology and Pneumo-Allergology Departments of Robert Debré Hospital (Paris), involving patients who had a negative OFC. Data were collected from the patients’ medical files and supplemented by a telephone survey. Results101 families completed the telephone survey, corresponding to 129 OFCs with full data available. The tested foods were tree nuts for 29.5 % (38/129), milk for 28.7 % (37/129), and egg for 21 % (27/129). Persistent avoidance represented 17.1 % of the OFCs (22/129), and partial consumption 4.6 % (6/129). Consumption of the tested food was inversely correlated with child's age and length of avoidance period. Consumption was more frequent in the case of ubiquitous allergens (milk, egg). The main causes mentioned for non-consumption were family habits (72.7 %, 16/22) or the child's disgust for the tested food (54.5 %, 12/22). ConclusionA negative OFC does not always result in actual consumption of the tested food at home. These results underline the importance of performing an OFC as early as possible in the patient's life. Monitoring and supporting patients who have a negative OFC is key for successful consumption at home.

BackgroundTo evaluate a nurse-driven respiratory support discontinuation protocol in infants with bronchiolitis admitted in paediatric intensive care units. MethodsA retrospective single-center study with pre-versus-post comparative design in a tertiary center. ResultsIn total, 187 infants (95 with standard and 92 with nurse-driven protocols) were included. There was no difference in terms of weaning failure between the two periods (11 (12 %) versus 14 (15 %), p = 0.46). During the nurse-driven protocol period, discontinuation of the ventilatory support was performed later (at 44 hrs (IQR 29–67) versus 33 hrs (IQR 19–46), p = 0.001), but the weaning process duration was shorter than before protocol implementation (24 h (IQR 0–60) versus 39 (IQR 18–64), p = 0.01). The total duration of ventilation (excluding time on BiPAP) was similar before and after protocol (53 (IQR 37–81) versus 55 h (IQR 28–81), p = 0.46). The PICU and hospital lengths of stay did not differ between the two periods. ConclusionsIn patients with bronchiolitis supported by noninvasive respiratory support, the nurse-driven discontinuation management - as opposed to physician-driven – was associated with a later discontinuation of the ventilatory support, while the weaning process duration was shorter than before protocol implementation.