The Revue Maghrébine de Pédiatrie (RMP) is the official scientific publication of the Tunisian Society of Pediatrics (STP). Its aim is to promote research and the dissemination of knowledge in the field of pediatrics and related disciplines. The journal publishes original articles, literature reviews, clinical cases and updates on various aspects of child health, including neonatology, nutrition, infectious diseases, pediatric cardiology and many other specialties. Intended for pediatricians, researchers and healthcare professionals, the Revue Maghrébine de Pédiatrie contributes to improving medical practice in Tunisia and across the Maghreb and beyond. It is a forum for scientific exchange that showcases research conducted regionally and internationally. A quarterly, bilingual (French/English) and open-access journal. ISSN 0330-7611.
Elevated Breast Milk Sodium and Seasonal Variation in Neonatal Hypernatremic Dehydration: A Descriptive Study from Northern Tunisia
Background: Neonatal hypernatremic dehydration (NHD) is an underrecognized and a potentially serious condition, particularly in exclusively breastfed infants. Frequently overlooked in the early postnatal period, it may cause severe complications. While postnatal weight loss is a known indicator, the specific role of breast milk composition and environmental factors remains understudied. This study describes the clinical features, contributing factors, management, and outcomes of newborns diagnosed with NHD in a neonatal unit in northern Tunisia. Methods: We performed a retrospective descriptive study including all neonates admitted for NHD to the neonatal unit of Habib Bougatfa Hospital (Bizerte, Tunisia) between January 2022 and December 2025. Hypernatremia was defined as serum sodium >145 mmol/L and classified as moderate (150–159 mmol/L) or severe (>160 mmol/L). Demographic, clinical, laboratory data, management, breast milk sodium levels and outcomes were analyzed. Results: Thirty-two neonates were included (sex ratio 1.13), with a mean age of 3.85 ± 1.88 days at admission. Most infants (84%) were exclusively breastfed. A striking seasonal clustering was observed, with all cases admitted between May and October. The mean weight loss was 13.5%, and fever was the predominant symptom. The mean serum sodium level was 150.8 ± 4 mmol/L (50% had moderate hypernatremia and 3% severe hypernatremia). The mean breast milk sodium concentration performed in 24 mothers was elevated at 59.3 ± 20.5 mmol/L (normal <7 mmol/L). Functional renal impairment was common (78.1%). All infants recovered fully with controlled fluid correction without neurological sequelae or mortality. Conclusion: NHD is preventable and primarily affects exclusively breastfed infants, especially during warm periods. Early recognition of feeding difficulties, monitoring of postnatal weight loss, and controlled correction of sodium imbalance are crucial. Enhanced breastfeeding support and maternal education are essential to prevent this condition while promoting safe exclusive breastfeeding.
Acute malnutrition in infants aged 1 to 6 months in Libreville: a multicenter study
Introduction: The nutritional status of infants aged 1 to 6 months has been little studied in our countries. Child malnutrition remains a major public health problem worldwide. Objective: To assess the nutritional status of infants aged 1 to 6 months in Libreville. Method: A multicentre, observational, prospective study with descriptive and analytical objectives, conducted over a four-month period. It involved healthy, full-term infants aged between 1 and 6 months. Bivariate and multivariate analyses were carried out to identify factors associated with malnutrition. Results: A total of 441 infants were registered. The average age was 3.06 months and the sex ratio was 0.93 in favour of females. Malnutrition was 13.8% (n=61), comprising 12 cases of moderate acute malnutrition (2.7%) and three (3) cases of severe acute malnutrition (0.7%). The risk of malnutrition was present in 10.2% (n=45) of infants. Overweight and obesity were found in 13.8% (n=61). Factors associated with the occurrence of malnutrition were the mother's level of education (p=0.002) and dietary errors (p<0.001). Conclusion: The prevalence of malnutrition among infants aged 1 to 6 months is significant in our context. Poor dietary habits are a risk factor for malnutrition in this age group. Promoting breastfeeding is therefore a key strategy for combating this condition.
Revue de l'article de David Szpilman et Paddy J Morgan publié en 2021 dans la revue Chest (Chest. 2021 Apr;159(4):1473-1483). Cet article décrit la physiopathologie et les particularités de la prise en charge pré-hospitalière et hospitalière de la noyade afin d'améliorer le pronostic et réduire la morbi-mortalité.
Pediatric Intensive Care and Emergencies
Behavioral disorder, mydriasis, fever, and subcutaneous emphysema: What diagnosis? — Rabies encephalitis: Preventable disease, inevitable outcome!
Hemolytic anemia and photosensitivity in infant
Congenital erythropoietic porphyria (CEP) is a rare inherited metabolic disease which usually manifests in early childhood with severe cutaneous photosensitivity, dark red urine and a variable degree of haematological involvement ranging from a mild hemolytic anemia to intrauterine hydrops fetalis. We report the case of a 4-month-old infant who was admitted for severe hemolytic anemia and red urines, who developed secondary severe cutaneous photosensitivity. The diagnosis of CEP was established on the basis of clinical symptoms and increased values of uroporphyrinogen and coproporphyrinogen in the plasma and urine.
Coeliac disease in children: think about other causes of growth retardation
Coeliac disease is an auto-immune enteropathy induced by gliadin ingestion. We report the cases of 3 children followed up for celiac disease. Gluten free diet was followed correctly with a good clinical response and negative celiac serologic testing. However, a slowing of the growth rate was observed; endocrinologic and genetic exams revealed respectively a Turner syndrome, a Growth hormone (GH) deficiency and an association GH and adrenal deficiency. GH supplementation was administered to all children with improvement of statural prognosis.
Pediatric Gastroenterology, Hepatology and Nutrition
Neurological involvement in pediatric inflammatory bowel disease: from the intestine to the brain, an already established link that is expanding
Background: Extra-intestinal manifestations of inflammatory bowel disease (IBD) are multiple but neurological involvement remains rare. Aim: Describe clinical and radiological features of central neurological manifestations in children with IBD. Methods: Retrospective study of pediatric patients with IBD and neurological involvement over a period of seven years. Results: 17 cases of IBD recorded; neurological manifestations were found in three patients: cerebral vasculitis, epilepsy, and cerebral venous thrombosis. Conclusion: It is necessary to think of central nervous system involvement in front of any child with IBD who presents with neurological manifestations.
Progressive intrahepatic cholestasis type 2 and citrin deficiency with a novel mutation: a case report
Citrin deficiency is a rare metabolic disorder which can lead to three clinical phenotypes. Herein, the authors describe a rare case of association between intrahepatic progressive familial cholestasis type 2 (PFIC2) and citrin deficiency with a novel mutation. A one-month-old male infant was referred to explore a prolonged jaundice. Molecular studies (next-generation DNA sequencing NGS) revealed a mutation of BSEP gene (ABCB11) and a pathogenic homozygous mutation in SLC25A13 gene encoding citrin. This identified mutation hasn't been described yet in the literature.
A factitious disorder masquerading as a hematemesis in a child
Factitious disorder, known in its extreme form as Munchhausen syndrome, is the deliberate and repeated production of symptoms in the absence of a physical or mental disorder. In the pediatric literature, attention has always been paid to Munchausen syndrome by proxy. We report the case of a factitious disorder masquerading as a recurrent hematemesis in a ten-year-old girl.
Une infection à parvovirus B19 mimant une maladie auto-inflammatoire
Parvovirus B19 (B19V) is a single-stranded DNA virus of the family Parvoviridae and genus Erythrovirus. Although the symptoms are often benign, some children may present severe forms. Our patient presented with prolonged fever, Macrophage activation syndrome and polyarthralgia. Parvovirus B19 DNA was isolated at serum PCR test.
Major sickle cell syndromes: epidemiological, clinical and outcome data
Background: Major sickle cell syndromes is a group of inherited diseases that includes sickle cell anemia, Hb SC and Hb SBetathalassemia. The aim of our study was to determine the epidemiological, clinical, hematological profiles and outcome of children with major sickle disease syndromes in a Hospital in south Tunisia. This is a retrospective study including children aged between 5 months and 14 years with SS sickle cell anemia or S β thalassemia. We collected 18 cases (13 boys and 5 girls). The average age at diagnosis was 30 months. During follow up, 9 patients developed vaso-occlusive crises, two patients developed brain stroke and four patients had acute chest syndrome. Conclusion: The diagnosis and management of SS sickle-cell disease are relatively late because of the absence of neonatal screening and low socioeconomic level of families.
Prématurité moyenne et tardive : devenir à court terme
Evaluation of card game in pediatric learning
Medical learning is a complex process traditionally based on theoretical lessons and practical training but it needs to incorporate innovative teaching tools, more suited to new students' generations. Gamification is one of these innovative tools which is being evaluated in medical education. This is a descriptive study on the implementation of a card game as a learning method in pediatrics. Three outpatient groups from the 2nd year of the Second Cycle of Medical Studies participated in this study. The results showed that the level of knowledge concerning the basic pathologies was heterogeneous with a disparity between the groups. The satisfaction forms showed that overall, the students were satisfied to very satisfied with this game session.
Séquestrations pulmonaires : étude de 7 observations
Introduction : La séquestration pulmonaire (SP) est une anomalie congénitale définie comme un territoire pulmonaire séparé du reste du parenchyme et présentant une vascularisation systémique anormale. Patients et méthodes : étude rétrospective des cas de SP colligés dans les services de néonatologie et de pédiatrie du CHU Hédi Chaker de Sfax (2007-2019). Résultat : Sept cas ont été colligés (5 garçons et 2 filles). Le diagnostic était suspecté en anténatal dans 3 cas. Deux patients ont été opérés avec confirmation du diagnostic de séquestration (1 cas) et d'une forme hybride (1 cas). Une seule patiente a eu une embolisation de l'artère de séquestration en France. Pour les 3 autres malades, une régression partielle de la SP était notée dans 2 cas. Conclusion : La séquestration pulmonaire est une malformation pulmonaire de plus en plus identifiée en anténatal. En post natal, 80 % des SP restent asymptomatiques avec la possibilité de régression spontanée.
Otitis media with effusion: from etiopathogenesis to treatment
Otitis media with effusion is a frequent pathology in children. It's due to tubal dysfonction and/or inflammation of the middle ear. The warning signs vary according to the age of the child. They can be hypoacusis, otalgia, a language disorder or school decline. The diagnosis is clinical and is confirmed by impedancemetry. An audiometric evaluation is mandatory before any treatment. Even the resolution of the disease is frequent, serious complications can occur such as repercussions on the tympanic structure and/or on the development of the child. Monitoring for three months is recommended in the absence of signs of seriousness. Medical treatment with corticosteroids and antibiotics has no place. Treatment is based on management of contributing factors and surgical treatment.
Convulsions et ataxie chez un enfant : quel est votre diagnostic ?
Artificial Intelligence Non-Invasive Methods for Neonatal Jaundice Detection: A Review
An Exceptional Cause of Diffuse Interstitial Pneumonia in Children: Genetic Pulmonary Alveolar Proteinosis
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by intra-alveolar accumulation of lipoproteinaceous material due to defective surfactant clearance by alveolar macrophages. In children, genetic forms mainly involve mutations of surfactant-related genes (SFTPB, SFTPC, ABCA3) and the GM-CSF receptor. We report the case of a 13-year-old girl born to consanguineous parents, presenting since age 3 with chronic dry cough and progressive exertional dyspnea. Chest CT revealed diffuse ground-glass opacities with a crazy-paving pattern. Bronchoalveolar lavage (BAL) yielded a milky fluid containing PAS-positive lipoproteinaceous material. Genetic analysis identified a mutation in the α-chain of the GM-CSF receptor. The patient underwent repeated whole-lung lavage procedures with gradual clinical and radiological improvement. Therapeutic lung lavage remains the standard of care, though newer approaches, such as inhaled or subcutaneous GM-CSF, plasma exchange, and rituximab, aim to restore macrophage function. Recent series report markedly improved survival, approaching 95 %.
The announcement of cancer in a child! An ethical and procedural skill to be developed by the pediatrician. Experience of the pediatrics department A, Tlemcen Mother and Child Hospital, Algeria
The announcement of a serious illness in a child is a difficult and sometimes complex situation for the pediatrician to manage. This announcement involves several actors, the doctor, the guardian and the child. The process of the announcement must obey ethical rules and must comply with the regulatory procedure, when dealing with a minor. The lack of knowledge of principles generates an atmosphere of misunderstanding between the family and the attending physician. We conducted a descriptive study among pediatricians in training and pediatric practitioners in the pediatrics department of the mother-child EHS of Tlemcen, Algeria, we were able to better understand that it is a multifactorial relational deficit. The lack of information about the regulations and the lack of knowledge of ethical rules are determining factors in the collapse of the medical relationship.
Pseudomonas aeruginosa as an Unexpected Cause of Early Neonatal Meningitis: Two Case Reports
Pseudomonas aeruginosa is a rare cause of neonatal meningitis, usually associated with nosocomial infection, prematurity, or immunodeficiency. We report two full-term neonates, one without identifiable risk factors and another in whom a health care–associated infection could not be excluded. The first presented with hematemesis and hypoglycemia, and the second with fever, jaundice, and hypotonia. Cerebrospinal fluid analysis in both cases showed pleocytosis, elevated protein, and low glucose. Cultures grew Pseudomonas aeruginosa. Both infants received targeted therapy including ceftazidime and ciprofloxacin. Head ultrasound revealed ventriculitis, subependymal hemorrhage, and white matter hyperechogenicity in one patient. Extensive investigations including immunological workup and sweat testing were normal. Both infants had favorable short-term outcomes.
Genetic testing in childhood epilepsy: what tests to send, whom to test, and why to test?
The role of genetics in childhood epilepsy has significantly expanded with the advancements in next-generation sequencing technologies. Genetic testing now plays a crucial role in diagnosis, prognosis, and precision therapeutics, particularly in developmental and epileptic encephalopathies and drug-resistant epilepsies. However, implementation remains uneven, leaving clinicians with frequent questions: Which test should I choose? When is testing justified? And why does it matter just beyond a molecular label? This review aims to synthesize current evidence on the utility of genetic testing in epilepsy, comparing available modalities, identifying the clinical scenarios where testing has the most impact, and outlining the therapeutic implications.
Protocole de Prise en charge d'une Bronchiolite grave
Recommandations tunisiennes pour la prise en charge standardisée des nourrissons ayant une bronchiolite grave, complémentaires aux recommandations de bonne pratique de la STP 2020. Objectifs : évaluer la gravité, mettre en place les différentes techniques d'assistance respiratoire (ONHD, VNI, VM) et proposer une escalade thérapeutique.
Schwartz-Jampel Syndrome (SJS) is an extremely rare autosomal recessive genetic disorder, only about 130 cases have been reported worldwide. Affected individuals present with distinctive craniofacial features, skeletal abnormalities (chondrodysplasia) and persistent muscle stiffness (myotonia). We present the case of a 3-year-old boy born to first-degree consanguineous parents, referred for global developmental delay with facial dysmorphism. Neurophysiological investigations demonstrated frequent myotonic discharges typical of SJS. The patient was treated with carbamazepine. By the time of his last follow-up at 17 years of age, his myotonia had shown slight improvement and the disease course was marked by learning difficulties, ataxic gait, and progressive worsening of skeletal deformities. This case of SJS highlights classic features alongside rare findings like neurodevelopmental delay and severe anemia, expanding its clinical spectrum.
Hémosidérose pulmonaire révélant un déficit en HLA classe II chez un nourrisson de 9 mois
Value of procalcitonin for the diagnosis of severe bacterial infections in infants under 6 months
Introduction: The management of febrile infants is often difficult. Procalcitonin has demonstrated its potential as an acute-phase biomarker for severe bacterial infections. Objective: The aim of this study is to compare the biologic parameters: procalcitonin, C-reactive protein, white blood cell and absolute neutrophil cell counts in detecting severe bacterial infections. Materials and methods: This prospective study included infants less than 6 months with fever over a period of 8 months. Results: Among 103 infants included, 42 (40.8%) were diagnosed as having a severe bacterial infection. Procalcitonin at a threshold of 0.305 ng/ml was the most effective for the identification of severe bacterial infection with a sensitivity of 90.5% and a specificity of 62.3%. In the multivariate analysis, procalcitonin at a threshold of 0.305 ng/ml, C reactive protein and fever ≥39° were associated with severe bacterial infections. Conclusion: Procalcitonin has better characteristics compared with traditional screening tests for identifying febrile infants less than 6 months with severe bacterial infection.
Prise en charge de l'acidocétose diabétique chez l'enfant (Selon les guidelines de l'ISPAD)
SARS-CoV-2 infection in HIV-infected children and adolescents in Togo
Introduction: SARS-CoV-2 and HIV infection are responsible for diseases that have rapidly reached pandemic scale, causing a significant burden of morbidity accompanied by fear among populations. The aim of this study was to describe the seroprevalence and clinical signs of SARS-CoV-2 infection in HIV-infected children in Lomé in 2022. Methods: This was a descriptive and analytical cross-sectional study conducted from April 01 to June 30, 2022 in HIV-infected children and adolescents followed up at 03 sites. Results: A total of 206 children and adolescents were included. Seroprevalence of SARS-CoV-2 was 85.4%. The age group most affected was between 15 and 19 years, and 84.5% of respondents detected as positive for SARS-CoV-2 had not been vaccinated. Among SARS-CoV-2 positive cases, 42 (23.9%) had reported at least one sign attributable to COVID-19. Cough (57.1%), fever (42.9%) and headache (45.2%) were the main symptoms reported. Conclusion: This study enabled us to confirm the frequency of SARS-CoV-2 infection, as well as the theory of a predominance of mild forms of COVID-19 over severe forms, in this population of HIV-immunocompromised children.
First Tunisian case of FGF12-related neonatal epileptic encephalopathy
Despite advancements in neonatal care, treatment of neonatal-onset epilepsy is complex and highly challenging. Here, we report the case of a Tunisian newborn whose seizures began at two days of life and whose genetic testing identified a recurrent de novo gain-of-function missense mutation in FGF12 gene (p.R114H in long isoform transcript, p.R52H in the short isoform transcript). The patient showed resistance to multiple antiepileptic treatments but noteworthy lamotrigine, escalated from 2.5 to 25 mg/day, resulted in an initial decrease in seizure frequency. Later the combination of phenobarbital (5 mg/kg) and valproic acid (VPA) (20 mg/kg) reduced the frequency of seizures substantially. At two years of age, the patient showed hypotonia with severe global developmental delay, occasional seizures, and required tube feeding. Our findings underscore the phenotypic variability and therapeutic challenges associated with FGF12-related epilepsy. Early seizure control is imperative for optimizing neurological outcomes in affected individuals, without mentioning the need for advanced research into gene-based treatment strategies.
Sensitization profile in asthmatic children: a retrospective study of 100 patients
Background: The prevalence of allergic asthma is increasing, with approximately 40% to 80% of asthmatic children having an allergic component. In Tunisia, the allergen profile found in most adult series shows a clear predominance of house dust mites, followed by pollen. The aim of this study is to investigate the sensitization profile of Tunisian children with asthma. Methods: This is a retrospective study of observations of patients followed up in consultation and/or hospitalized in the Children's Medicine B department of the Tunis Children's Hospital, over a 5-year period from January 1, 2013 to December 31, 2017. Results: We studied 100 children, with a sex ratio of 1.09. The mean age of onset of symptoms was 4 years and 11 months. 34% of our patients had a history of familial atopy. Personal atopy was observed in 53% of patients. Prick tests were carried out on all patients, and was positive in 68%, with a predominance of house dust mites. Conclusion: The sensitization profile of our patients showed a predominance of house dust mites as the implicated pneumallergen and a sensitization rate of 68% among our asthmatic patients.
Pediatric malaria management: Report on 312 cases at Angré University Hospital (Abidjan - Côte d'Ivoire)
Introduction: Malaria is the leading cause of hospitalization and death in children. The aim of the study was to evaluate the management of malaria in children at Angré University Hospital, with a view to improving prognosis and professional practice. Material and methods: This was a prospective, analytical study conducted in the pediatrics department of CHU d'Angré from January 1 to December 31, 2021. It focused on children aged 0 to 15 presenting with simple or severe malaria confirmed by biology with an antimalarial prescription. Results: 312 children were enrolled, 50.6% of them male. Mean age was 4.6 years; 72.7% of cases were under 5 years of age and 26% slept under impregnated mosquito nets. Anaemic and neurological forms accounted for 68.6% of severe malaria. Artemeter-Lumefantrine (ACT) combinations (87.8%) were prescribed in cases of uncomplicated malaria. Artesunate was prescribed in cases of severe malaria (99%). The average length of hospital stay was 3 days, and the death rate was 3.2%. The case-fatality rate for severe malaria in this study was 13.2%. Conclusion: Malaria in children is severe, with a high case-fatality rate, hence the need for better preventive (LLINs, vaccination) and curative management of malaria and anemia in children.