Pediatric Consultation Research Articles

Correlation between Chest Radiograph and Lung Ultrasound with Clinical Appearance in Hyaline Membrane Disease Patients

ABSTRACT Background: Hyaline membrane disease (HMD) is a respiratory distress disease in premature infants due to surfactant deficiency. The combination of clinical, laboratory and radiological features makes it easy to quickly, precisely & accurately establish HMD which is important for early therapy in preventing death. Purpose: Knowing the suitability between chest X-ray & Thorax ultrasound with the clinical picture in HMD patients. Methods: This study is an observational study with a cross sectional method conducted in the radiology & NICU section of Dr. Wahidin Sudirohusodo Makassar from August 2021 to January 2022. Sampling was done by consecutive sampling. The researcher performed a thorax ultrasound & assessed the chest x-ray. The results were verified by two pediatric radiology consultants. Results: The largest sample was in neonates at 34 weeks of gestation, 8 samples (21.1%), sex with 25 samples (65.8%), the highest birth weight between 1000-2000 grams 32 samples (84.2%) , the most preterm etiology was due to severe preeclampsia in 13 samples (34.2%), the most deliveries were by cesarean section 34 samples (89.4%), the highest APGAR Score was in moderate degree 25 samples (65.8%), the highest O2 saturation was between 90 -94%, namely 24 samples (63.2%), the most down scores were moderate degrees 15 samples (39.5%), HMD degrees based on chest radiographs were mostly grade II 25 samples (65.8%), HMD degrees based on thorax ultrasound the most in the moderate degree 19 samples (50%).Conclusion: Ultrasound is considered as the radiological modality of choice because it is safe, inexpensive, easy & sensitive to assess respiratory distress in neonates but is influenced by the operator's ability to apply it.Keywords: hyaline membrane disease, down score, chest radiograph, lung ultrasound

Dermatologic masks of Langerhans cell histiocytosis. Case report

Langerhans cell histiocytosis (LCH) is a rare pathology in pediatric age with heterogeneous clinical presentation in skeletal system, skin, central nervous system, liver, spleen, lungs, lymph nodes and bone marrow. Therefore, a number of diagnostic mistakes increase and inadequate therapy administrates. For a diagnostic period, a try at treatment, LCH disseminates with organs and systems involvement and at the moment of morpho-immunologic diagnosis verification, a disease characterizes as multiorgan multiple site affection, which decreased survival rate. In the current issue a clinical case of LCH with mistaken prolonged (2 year) atopic dermatitis anamneses is presented. The absence of pronounced effect of topical therapy along with nontypical for atopic dermatitis became not an indication for skin biopsy. After appearance of systemic symptoms with anemia, leuko- and thrombocytopenia became an evidence for pediatric oncologist-hematologist consultation.

Evaluation of Streamed Hardware-to-Software Telemedicine Strabismus Consultations Utilizing Video Glasses.

While video glasses have been shown to be an effective tool for real-time pediatric strabismus telemedicine consultations, the high cost of the hardware-to-hardware conferencing system and bandwidth limitations may present barriers to accessibility and widespread adoption. This study evaluates the use of video glasses with a more affordable hardware-to-software video conferencing system for real-time strabismus consultations across multiple graders. A pediatric ophthalmologist (Grader 1) wearing video glasses simultaneously performed and recorded strabismus examinations in primary gaze, with and without correction, both at distance and near. Recorded parameters included strabismus category, angle measurements, and ocular motility. Three years later, four pediatric ophthalmologists (Graders 1-4) reviewed and graded streamed video feed transmitted at 1 megabit per second (Mbps) from a hard-wired codec to software. Agreement between streamed and gold standard in-person findings was determined by weighted kappa (κ) for categorical variables, intraclass correlation coefficient (ICC) for continuous variables, and percent agreement. Eighteen patients aged 4-11 years (median, 7 years) were included. Agreement in strabismus category between in-person and streamed examinations was perfect for both horizontal and vertical deviations (κ=1.0). Almost perfect agreement was found for degree manifest (tropia vs intermittent tropia vs phoria) across graders (κ=0.91, range 0.86-0.97). Agreement for angle measurements was excellent across graders (ICC = 0.97, range 0.97-0.98). Extraocular motility agreement was 90% for all graders combined, with Grader 1 having 100% agreement between her in-person and streamed examinations. Feed obtained from video glasses streamed through a hardware-to-software video conferencing system at 1 Mbps is a reliable tool for pediatric strabismus telemedicine evaluations.

(8) Characterization of Pediatric Telephonic Psychiatric Consultation for Infant Mental Health

(8) Characterization of Pediatric Telephonic Psychiatric Consultation for Infant Mental Health

Infantile Periarteritis Nodosa (About 5 Cases and Review of the Literature)

PAN is an inflammatory and necrotizing vasculitis affecting small and medium caliber arteries of the body, rarely described in children. Its pathophysiology is complex and remains poorly elucidated, involving the deposition of circulating immune complexes in the vascular wall, neutrophil anti-cytoplasmic antibodies, the role of cytotoxic lymphocytes, cytokines, environmental factors (infections), as well as genetic susceptibility (mutations in ADA 2 and the MEFV gene). There are two main forms: a classic systemic form with visceral involvement (60% of cases) and a cutaneous form with lesions limited to the skin and muscles (30%), which usually evolve less severely. Positive diagnosis is based on the Eular/Printo/Pres criteria. The treatment depends on the form of PAN, and relies essentially on NSAIDs, colchicine, corticotherapy and immunosuppressants: azathioprine and cyclophosphamide. Our work is a retrospective study of 5 cases of PAN, collected at the IV pediatric department and the pediatric rheumatology consultation of the children's hospital of Rabat between 2009 and 2014: The diagnosis was retained on the criteria of Eular/Printo/Pres. The clinical picture was dominated by skin and joint involvement. One of our patients presented an atypical picture of PAN associated with infective endocarditis and large vessel involvement. All of our patients received corticosteroid therapy, and one of our patients benefited́ in addition to colchicine.

Differential diagnosis in children with musculoskeletal pain in Emergency Department

Objective: The study was aimed to analyze the diagnostic approach to a child with a non-traumatic musculoskeletal pain registered in the pediatric Hospital Emergency Department (HED). Since the pandemic COVID-19 affects patient health and the healthcare system, we also evaluated the impact of pandemic on type of musculoskeletal symptoms.
 Study design: A retrospective cross-sectional study was conducted by statistical analysis of data of patients with non-traumatic musculoskeletal pain registered in HED between January 2018 and December 2020. Data of patients referred and not referred to hospital ward and admitted to HED before and during COVID-19 pandemic have been compared.
 Results: Majority of patients presented acute, non-trauma related, single-site pain, usually localized in the hip, the knee and the spine. 21,49% of patients were referred to a hospital ward, usually rheumatological, neurological or orthopedic. Final diagnoses in almost ¾ patients belong to the group of musculoskeletal system and connective tissue disorders. During the pandemic significantly less patients with musculoskeletal pain reported to our HED. The duration of symptoms before admission was not significantly longer than in previous years, but the problem in children and the impact of the pandemic on the musculoskeletal system in children is complex.
 Conclusions: Our study provides detailed information on patterns of pediatric musculoskeletal consultations in HED. A positive history of trauma preceding musculoskeletal pain in a child may only be accidentally related to the final cause. Musculoskeletal pain can be also a symptom of a lot of various systemic conditions, not only diseases of the musculoskeletal system. The still ongoing COVID-19 pandemic may require changes in the organization of the HED. We believe that the presented results can help in organizing and planning care in pediatric HEDs, develop diagnostic algorithms and training for HED staff.

Extracorporeal membrane oxygenation and paediatric palliative care in an ICU.

Compare rates, clinical characteristics, and outcomes of paediatric palliative care consultation in children supported on extracorporeal membrane oxygenation admitted to a single-centre 16-bed cardiac or a 28-bed paediatric ICU. Retrospective review of clinical characteristics and outcomes of children (aged 0-21 years) supported on extracorporeal membrane oxygenation between January, 2017 and December, 2019 compared by palliative care consultation. One hundred children (N = 100) were supported with extracorporeal membrane oxygenation; 19% received a palliative care consult. Compared to non-consulted children, consulted children had higher disease severity measured by higher complex chronic conditions at the end of extracorporeal membrane oxygenation hospitalisation (5 versus. 3; p < 0.001), longer hospital length of stay (92 days versus 19 days; p < 0.001), and higher use of life-sustaining therapies after decannulation (79% versus 23%; p < 0.001). Consultations occurred mainly for longitudinal psychosocial-spiritual support after patient survived device deployment with a median of 27 days after cannulation. Most children died in the ICU after withdrawal of life-sustaining therapies regardless of consultation status. Over two-thirds of the 44 deaths (84%; n = 37) occurred during extracorporeal membrane oxygenation hospitalisation. Palliative care consultation was rare showing that palliative care consultation was not viewed as an acute need and only considered when the clinical course became protracted. As a result, there are missed opportunities to involve palliative care earlier and more frequently in the care of extracorporeal membrane survivors and non-survivors and their families.

'That's what makes me better': Investigating children and adolescents' experiences of pain communication with healthcare professionals in paediatric rheumatology.

Pain communication should be an integral part of clinical consultations, particularly in paediatric rheumatology where children and adolescents frequently present with chronic musculoskeletal pain. To date, literature exploring the nature of and extent to which pain communication occurs has focused on healthcare professionals as respondents, yielding inconsistent and incomplete findings. The aim of this study was to explore children and adolescents' experiences of pain communication in the context of paediatric rheumatology consultations. Data were collected using semi-structured telephone interviews with children and adolescents recruited from three tertiary paediatric rheumatology centres in the United Kingdom. A framework analysis approach was used to explore the similarities and divergences in participant accounts. Twenty-six children and adolescents (aged 6-18 years, median=14, 58% female) participated. Diagnoses included: juvenile idiopathic arthritis, Chronic Idiopathic Pain Syndromes, Ehlers Danlos Syndrome/Hypermobility. Four themes were identified: (1) Co-ordination of pain communication; (2) Barriers to pain communication; (3) Facilitators of pain communication; (4) Dissatisfaction with pain communication. These themes particularly encompassed the process of communication, disclosure of effective and ineffective approaches and the impact of communication. Participants expected questions about pain, felt cared about and found talking about pain natural. Challenges included augmenting the feeling of being different to peers and concerns about management plans changing as a result of pain conversations. Children and adolescents recalled a range of effective and ineffective pain communication approaches. Our study informs recommendations which highlight how healthcare professionals can improve their communication about pain with children and adolescents in the future. Our findings demonstrate that children and adolescents attending paediatric rheumatology expect to be and value being asked about their pain during consultations with healthcare professionals. Children and adolescents remember many of the processes involved, experiences of and the outcomes of pain communication. The current study reveals insights which can improve healthcare professional pain communication with children and adolescents. Our study introduces key recommendations for healthcare professionals to have more effective pain conversations in future.

20 Eat Sleep Console: A Quality Improvement Initiative to Improve the Care of Opioid Exposed Newborns at a Community Hospital

Abstract Background As the opioid crisis continues in B.C., more infants are born to mothers using opioids during pregnancy. Many of these newborns experience neonatal opioid withdrawal syndrome (NOWS) and require specialized medical care and prolonged hospital stays. Objectives We sought to improve the care of opioid exposed newborns by replacing the Finnegan Neonatal Abstinence Scoring System (FNASS) with the Eat Sleep Console (ESC) protocol. Our aim was to reduce infant NICU length of stay (LOS) and morphine dosing required for withdrawal management. Design/Methods A multi-disciplinary team was formed in 2019 and standard quality improvement methodology was implemented using plan-do-study-act cycles. Interventions included NOWS education for maternity and newborn health care providers, pediatric antenatal consults, introduction of as needed morphine, and implementation of the Eat Sleep Console (ESC) assessment tool. Primary outcomes were number of NICU admission days and cumulative morphine dosing required for NOWS treatment. Data from chart reviews was obtained from 2017 to 2021. Qualitative survey data was collected from nursing staff pre and post ESC implementation. Results ESC successfully replaced the FNASS, and nursing staff reported overall satisfaction and confidence with the practice change. Forty-four infants were captured in our data analysis, including 21 from the baseline period (FNASS), 12 from intervention group 1 (PRN morphine and FNASS), and 9 from intervention group 2 (PRN morphine and ESC). Cumulative morphine dose decreased by 55% when comparing the two intervention groups (19.45 mg intervention group 1 vs 10.71 mg intervention group 2). Two infants were managed exclusively with ESC non-pharmacological strategies and did not require any morphine. Although NICU LOS increased over time in our project (10.79 days in the baseline group vs 19.64 in the intervention group 2), there were no differences in the LOS between the two intervention groups (18.49 days vs 19.64 days). Unstable maternal opioid use, defined as illicit opioid use two weeks prior to delivery increased as the project progressed and was unbalanced between groups, possibly affecting our overall outcomes (38% unstable mothers in the baseline period vs 78% intervention group 2). Stratified analysis between stable and unstable mothers showed a trend of increased LOS and morphine requirements for infants born to unstable mothers. In our center, the ability to provide 1:1 care by nurse or parent was the most prominent challenge. Conclusion ESC successfully replaced the FNASS at our community hospital and has shown a clinically significant decrease in morphine requirements for infants experiencing opioid withdrawal.

Anemia in children aged 6 to 59 months attending a quaternary health facility in Maputo, Mozambique

Abstract Background Globally, anemia prevails as a public health issue, being also a concern in Mozambique, where about two-thirds of children 6-59 months of age are affected by anemia. We carried out this study to estimate anemia prevalence and evaluate structural determinants and hematological parameters association among children aged 6 to 59 months attending pediatric inpatient and outpatient services in a Quaternary Health Facility in Maputo City Province, Mozambique. Methods From August 2021 to January 2022, we conducted a cross-sectional study at the ‘Maputo Central Hospital’ where we collected data from 397 inpatients or outpatients who attended pediatric consultations. The cut-off values for anemia were: mild (10g/dL≤Hb≤10.9g/dL), moderate (7g/dL≤Hb≤9.9g/dL), severe (Hb &amp;lt; 7.0g/dL). We used SPSS 28.0 software to perform descriptive analyses and Chi-Square tests. Results Our preliminary findings show that the total rate of positive cases was 30.0% moderate anemia (119/397), 23.9% mild anemia (95/397), and 7.3% severe anemia (29/397). Anemia frequencies were higher in male patients unregarding the type (54.2% moderate, 62.1% mild, 67.9% severe). Anemia prevalence was higher among children aged 24-59 months (41.2% moderate, 47.4% mild, 51.7% severe; p &amp;lt; 0.05). The rate of all anemia types was higher in children from rural areas and Maputo City province relative to those from urban areas and other country provinces. The level of education of the child's companion to the consultations was associated with anemia (p ≤ 0,05), with higher rates observed in secondary level education. We observed no association between iron or serum ferritin values to anemia. Key messages • Children aged 24-59 months, children from rural areas, and who are male are more vulnerable to suffering anemia than their peers, thus needing more monitoring during their growth. • Nutritional-anemia-specific interventions targeting the first 1000 days of life may be helpful to its reduction in children.

Factors associated with mothers’ health care-seeking behaviours for childhood fever in Burkina Faso: findings from repeated cross-sectional household surveys

IntroductionFever is one of the most frequent reasons for paediatric consultations in Burkina Faso, but health care-seeking behaviours and the factors associated with health care-seeking in the event of childhood fever are poorly documented. This study aims to analyse the health care-seeking behaviours and the factors associated with health care-seeking for childhood fever in Burkina Faso.MethodsThis study used the data from the baseline and endline surveys conducted to evaluate the impact of the Performance-Based Financing program in Burkina Faso. Univariate and multivariate binary logistic regression analyses were used to identify the factors associated with appropriate healthcare-seeking for childhood fever. Odds ratios were estimated to assess the strength of associations and 95% confidence intervals (CIs) were used for significance tests. Data were cleaned, coded and analysed using Stata software version 16.1.ResultsAmong the children under five who had a fever, 75.19% and 79.76% sought appropriate health care in 2013 and 2017, respectively. Being 24–59 months old (AOR: 0.344, 95% CI 0.182–0.649 in 2013 and AOR: 0. 208, 95% CI 0.115–0.376 in 2017), living in a very wealthy household (AOR: 2.014, 95% CI 1.149–3.531 in 2013 and AOR: 2.165, 95% CI 1.223–3.834 in 2017), having a mother with a secondary or higher level of education or having made at least four antenatal care visits were significantly associated with seeking appropriate health care for childhood fever. Living in an area where the health facility is safe was also significantly associated with seeking appropriate care for childhood fevers.ConclusionsThe findings underscore the need to concentrate efforts aiming at sensitizing the population (especially women of childbearing age) to improve sanitation and the use of family planning (household composition), skilled antenatal care and postnatal care to help reduce the prevalence of fever in children under five and improve the use of medical healthcare for childhood fever.

Post-discharge follow-up attendance after pediatric dermatology consultation in the emergency department: A retrospective analysis.

The emergency department (ED) is a frequent source of care for pediatric patients with dermatologic conditions, possibly owing to limited access to routine and urgent outpatient dermatology appointments. The demographics, clinical characteristics, follow-up scheduling practices, and attendance rates of 50 pediatric and 142 adult patients evaluated by the dermatology consult service in the ED were reviewed. High rates of follow-up attendance were observed in the pediatric and adult populations, with the majority receiving an appointment within 2 weeks. The dermatology consult service may play an important role in facilitating post-discharge access to outpatient care.

Supporting Challenging Pediatric Intensive Care Conversations with Remote Presence Robotic Technology

In a community hospital setting, Remote Presence Robotic Technology (RPRT) has been used for pediatric intensive care consultations. Two casesare presented where RPRT was used for acute resuscitation, delivering bad news, and discussions regarding end-of-life care. Although the medical contexts of the cases differed, RPRT demonstrateda versatility and role for very sensitive and difficult conversations.

28 Osteoarticular manifestations simulating JIA in acute leukemia: case report and literature review

BackgroundThe osteoarticular manifestations are proven during hematological malignancies in children, they can be the revealing symptom of the disease, and they may simulate a full clinical picture of Juvenile Idiopathic Arthritis (JIA), especially if no blasts are found in blood smear. Some therapies are common to both diseases, which commonly delay diagnosis for a couple of months and worsens the prognosis of these malignancies. We report three observations of patients treated for JIA which turned out to be acute leukaemia.Clinical caisesThe first patient is a 7-year-old male followed in pediatric rheumatology consultation for a monoarticular onset JIA. Since the patient did not respond to indomethacin, a bone marrow examination (BME) was performed before corticosteroid therapy (CST), no blasts were found. The patient received 01 month of CST which led to the amendment of clinical and biological signs, however, joint pain and bicytopenia reappeared after we started CST reduction. Blood and blood marrow smear were performed, leading to the diagnosis of acute B-lymphoblastic leukaemia.The second patient is a 4 years old male admitted for exploration of polyarthritis with cervical lymphadenopathy, the initial assessment allowed the diagnosis of JIA with polyarticular onset. Indomethacin is prescribed, without any improvement. Radiological assessment was performed, as well as a complete blood count (CBC) which found neutropenia with lymphopenia, and blasts were discovered in the second BME.The third patient is a 6-year-old female admitted for exploration of arthralgia and pathological fractures. Radiological signs in favor of leukaemia and normochromic aregenerative normocytic anaemia were revealed, allowing the diagnosis of ALL B to be made after several consultations in rheumatology.DiscussionJoint damage during leukaemia, called leukaemic arthritis, is frequent, complicating 12% to65% of pediatric leukaemia, most often ALL. It is linked to specific damage by leukaemic infiltration of the synovium or less likely to a synovial reaction to adjacent periosteal or capsular infiltration. In JIA there are incomplete or atypical forms, the differential diagnoses to be sought are numerous and depend on age, personal and family anamnesis and clinical, biological, hematological and radiological signs. The dread of a haematological malignancy must constantly be sought and excluded before the use of CST, which is one of the therapeutic weapons in ALL, thus causing the blasts to disappear and delaying the diagnosis.ConclusionThe diagnosis of JIA must be made with caution, raise the possibility of haematological malignancy in children in the absence of response to usual treatments, in the presence of systemic signs such as fever or a persistent biological syndrome or atypical radiological lesions, hence the correct analysis of the CBC and the blood and marrow smears is clearly important.

Impact of a pediatric infectious disease consultation service on timely step-down to oral antibiotic treatment for bone and joint infections

PurposeIn recent years an earlier step down to oral antibiotic therapy has been advocated for numerous infections. Trained infectious disease specialists regularly consulting their colleagues may speed up the implementation of such recommendations into clinical practice and thus may improve treatment.MethodsWe retrospectively analyzed bone and joint infections in children admitted to the University Hospital of Cologne between 2010 and 2021. We assessed clinical, imaging, and microbiological findings and treatment modalities. Additionally, we assessed both the impact of a newly implemented pediatric infectious diseases consultation service and publications on revised treatment recommendations by comparing antibiotic therapy in two periods (2010–2016 versus 2017 to 2021).ResultsIn total, 29 children presented with osteomyelitis, 16 with bacterial arthritis and 7 with discitis. In period 2 (2017–2021) we observed shorter duration of intravenous treatment (p = 0.009) and a higher percentage of oral antibiotic treatment in relation to the total duration of antibiotics (25% versus 59%, p = 0.007) compared to period 1 (2010–2016).Yet, no differences were identified for the total length of antibiotic treatment. Additionally, biopsies or synovial fluid samples were retrieved and cultured in more children in period 2 (p = 0.077). The main pathogen identified in osteomyelitis and bacterial arthritis was Staphylococcus aureus (MSSA), diagnosis was confirmed predominantly with MRI.ConclusionRecent guidelines addressing the safety of an earlier step-down (to oral) antibiotic therapy have influenced clinical practice in the treatment of bone and joint infections in our hospital. A newly implemented pediatric infectious diseases consultation service might have accelerated this progress resulting in a faster step down to oral treatment.

Infectious Endocarditis in Children: Epidemiological, Clinical, Paraclinical and Therapeutic Profile

Introduction: Infective endocarditis (IE) in children is a serious pathology with high mortality and morbidity. The aim of our study was to describe the clinical, microbiological, therapeutic and evolutionary characteristics of infective endocarditis in children. Materials and methods: This is a retrospective study, listing all children aged less than 15 years, diagnosed in pediatric cardio consultation and hospitalized in the department of Pediatrics A-Mother and Child Hospital of Marrakech for infective endocarditis between 2010 and 2020. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form. Results: During the study period, 25 children presented with infective endocarditis, with a sex ratio equal to 1.08. The mean age of the patients was 9 years and 6 months. Underlying heart disease was found in 76% of cases. A cardiac murmur was noted in 96% of cases, and the most frequent germs were Staphylococcus and Streptococcus. Cardiac ultrasound revealed endocardial vegetations in 72% of the children. Intravenous antibiotic therapy was initiated in all children for a median of 45 days, and an indication for valve replacement was given in 16% of cases. According to the modified Duke criteria, 28% of the infective endocarditis cases were definite and the evolution was favorable in 80% of the children. The most frequent complications were valve failure, heart failure, and embolic complications, and death in 5 cases. Conclusion: The analytical study concluded that embolic complications, heart failure and neurological complications are predictive of mortality. Therefore, its management must be multidisciplinary, early and adequate.

3.80 Pediatric Telephonic Psychiatric Consultation for Early Childhood and Infant Mental Health

In response to limited access to child and adolescent psychiatrists, Children’s Telephonic Psychiatric Consultation Service (TiPS) provides real-time consultation to primary care providers (PCPs) for pediatric patients with mental health (MH) concerns. It is estimated that 8% to 10% of children younger than 6 years old (yo) experience clinically significant MH problems, yet access lines have typically focused on older children. Our objective is to characterize pediatric telephone consultation for this younger group.

40.4 A Systems of Care Response to the Pediatric Mental Health Patient Surge: Creation of a Pediatric Psychiatric Consult Service to the Emergency Department and a Bridge Clinic

This presentation will describe the impact of a pediatric psychiatric consult service (PPCS) to the emergency department (ED) and a bridge clinic on the pediatric mental health patient surge and boarding crisis. There will also be a discussion about how the bridge clinic functioned in providing a hospital system alternative for some pediatric crisis patients and its impact on the boarding crisis.

3.35 Predictors of Accurate ASD Diagnosis by a General Pediatrician Compared to a Multidisciplinary Team

This study determined the accuracy of ASD diagnostic assessments conducted by consultant general pediatricians compared to a multidisciplinary team (MDT), as well as the predictors of accurate assessment.

Congenital Cutis laxa: Two pediatric cases

The Cutis laxa syndrome is a group of rare heterogeneous disorders of the elastic tissue characterized mainly by wrinkled, loose skin giving an aged appearance, which may be associated with skeletal abnormalities, developmental abnormalities, and even severe systemic involvement. Cutis laxa syndrome (CL) is either acquired or congenital. There are several forms of congenital cutis laxa distinguished according to the mode of transmission, the extent of visceral involvement, associated anomalies, and the severity of the disease: autosomal dominant CL, autosomal recessive CL, X-linked CL. In the light of data from the medical literature and through the observation of 2 sisters followed up in a pediatric dysmorphology consultation for congenital cutis laxa, the authors underline the clinical, paraclinical, etiogenotypic, therapeutic, and evolutionary peculiarities of this rare disease.