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This study aimed to analyze acute renal failure in perinatal asphyxia (PNA) of term newborns in a sub-Saharan urban health center.The study was prospective, conducted from 1st June to 30th November 2013 on term newborns hospitalized at the centre hospitalier universitaire pédiatrique Charles-de-Gaulle for PNA. Renal insufficiency (RI) was defined by a serum creatinine greater than or equal to 90 μmol/L.Eighty-five PNA cases were included, or 19.8% of newborns hospitalized in the study period. The sex ratio was 2.1. Thirty-eight newborns (44.7%) had RI. Their creatinine averaged 153.8±96.6 μmol/L. Twenty-six of 38 (68.4%) had brain damage in Sarnat stage 2 and 12 (31.6%) stage 3. Twelve newborns with RI (31.6%) had seizures. Transfontanellar echography revealed an abnormality in 30 cases (78.9%) of RI. Of the 38 newborns with renal failure, albuminuria was found in 21 cases (65.2%) and leukocyturia in 28 cases (73.7%). Renal function improved in 86.1% of cases. Newborns with initially normal serum creatinine had no RI during hospitalization. Six newborns (7.1%) died.This study showed that acute RI is common during PNA most particularly in newborns with severe neurological impairment. In our context, earlier support for women in labor could help prevent PNA and therefore newborn acute RI.

Antineutrophil cytoplasmic antibodies (ANCA) are usually considered as serological markers of vasculitis (microscopic polyangiitis, granulomatosis with polyangiitis, and Churg-Strauss syndrome), but they have also been described in other diseases. They are rarely observed in children. Therefore, this study aims to describe the clinical spectrum associated with positive ANCA in children.All the children below 15 years of age, admitted to the Angers University Hospital between June 2004 and June 2010 presenting with an ANCA-positive test by indirect immunofluorescence were included in this study. The exhaustive list of ANCA-positive children was obtained from the immunology unit. Six antigenic targets were routinely tested by Elisa, i.e., proteinase 3, myeloperoxidase, bactericidal permeability increasing protein, cathepsin G, elastase, and lactoferrin. Clinical and biological data were retrospectively collected.Thirty-seven children were identified with positive ANCA in this 6-year period. None of the antigenic targets tested was found in 21 patients. The most frequent diseases associated were inflammatory bowel disease (n=10), infections (n=6), hematological disease (n=5), and juvenile idiopathic arthritis (JIA) (n=4). Patients with JIA presented with a predominance of antielastase antibodies.In contrast to the findings usually observed in adults, we obtained a wide spectrum of clinical entities associated with positive ANCA in this cohort. In children, the ANCA test has 2 advantages: to diagnose systemic vasculitis and to differentiate inflammatory bowel disease. Patients with JIA seemed to have more frequent antielastase antibodies: in the future, this finding should be further investigated in larger prospective studies.

Urinary tract infection (UTI) is one of the most common infections in children but Haemophilus is rarely involved. In our institution, only 3 children below the age of 15 years presented with UTI due to Haemophilus influenzae between January 2010 and October 2011. These children had typical symptoms of UTI: fever, abdominal pain and dysuria. In all 3 patients, standard urinalysis remained negative, but H. influenzae was found after bacterial growth in special media, i.e., blood agar (or chocolate agar). These patients had abnormalities of the urinary tract. The first patient, a 5-year-old girl, had a right ureteropelvic junction syndrome found after her UTI. The second, a 4-year-old girl, had a bilateral ureteral duplication found after many UTIs. The third, a 2-month-old boy, had a right ureteropelvic junction syndrome that had been diagnosed by prenatal ultrasound. In our hospital, during the study period, the prevalence of UTI caused by Haemophilus was 0.02% of all pediatric UTIs. There are few reports in the literature on UTI caused by Haemophilus in children (1%): they are frequently associated with urinary tract abnormalities. The bacterium is not able to grow in usual media, so that when there is a clinical UTI with Gram negative bacilli on the direct exam but not found in the culture, an infection with Haemophilus should be discussed, and blood agar used, which is all the more important when there are underlying abnormalities of the urinary tract.

The aim of this study was to describe the intensive care unit neonatologists' attitudes about a neonate with terminal or pre-terminal renal failure.A questionnaire was sent to all French neonatal intensive care units. Physicians were asked to describe their attitude about neonatal chronic renal failure (Would you agree with dialysis and graft for these children?). Physicians were also presented with two clinical observations involving neonates with varying degrees of renal insufficiency and a complicating comorbidity, including neurological abnormality or socioeconomic circumstances.Responses were obtained from 92% of the university neonatal care units. The will to take care of a neonate with end-stage renal failure till the renal graft, varied greatly from a centre to another one. Three (9%) university-teams said they had a strong will to bring the baby from the neonatal period to the time of renal graft. Eleven other centres (32%) did not have any will for accompanying the baby till the renal graft. Eight centres (24%) would be rather favourable to the idea of dialysis and graft, and 12 others (35%) would be rather unfavourable.The results of this study show great differences between French neonatologists when they are faced to newborns with end stage renal failure. Ethical, medical and organisational difficulties are matters of controversy. The epidemiological impact of the perinatal discussion could be a 20% variation of all the renal grafts in children.

Malformative uropathies diagnosed in utero are increasing in number. This work describes the decision strategy adopted in Angers concerning the neonatal handling of those abnormalities.One hundred children born between 1988 and 1990, with prenatally suspected fetal uropathy, were included in the study and followed for a period of 3 years. In every case, an ultrasound scan was performed at birth. In cases with persistent abnormality, a voiding cystourethrography was done in the first week of life. An intravenous urograph and/or a nuclear renography were performed during the second month of life.Twenty-nine children were normal. Seventy-one were affected by 126 isolated or related uropathies; the most frequent ones were the ureteropelvic junction obstruction syndrome (48), ureterovesical junction obstruction (18) and multicystic kidneys (13). A vesicoureteral reflux was associated in 22% of cases. The diagnosis was perfectly correlated with the prenatal diagnosis in 50% of cases. Fourteen of the normal children had a later ultrasound scan control, between 2 and 9 months; later on, three of them showed a moderate ureteropelvic junction obstruction syndrome. Amongst the 48 ureteropelvic junction obstruction syndromes, 22% have been operated on. The others obstructive uropathies remained stable or spontaneously improved.These results require us to discuss as matter of priority the large number of spontaneously regressive prenatal hydronephrosis and the necessity to establish a consensus for the pre and postnatal pathological thresholds of the anteroposterior pelvic diameter, the interest in carrying out a voiding cystography after the birth when dilatation is confirmed, the interest of nuclear renography for the diagnosis and follow-up of obstructive uropathies and the absence of urgency for surgery.We propose a decision tree specifying the action to take when facing the diagnosis of a prenatal hydronephrosis. It could be a part of the reflection for the medical teams handling these uropathies is the aim of a consensual attitude which is now essential.