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Intranasal delivery of sedative or analgesic drug can be an easy, effective, and secure alternative to intravenous administration when not possible or not justified. Some neonatal studies have explored the feasibility of sedation with nasal midazolam or dexmedetomidine for intubation or radiological investigation. Fentanyl is the commonest analgesic medication by this route, Ketamine is another option. Utilization in a population at risk of respiratory distress should be done with caution. [ABSTRACT FROM AUTHOR]

The persistence of adult health and mortality socioeconomic inequalities and the equally stubborn reproduction of social class inequalities are salient features in modern societies that puzzle researchers in seemingly unconnected research fields. Neither can be satisfactorily explained with standard theoretical frameworks. In the domain of health and mortality, it is unclear if and to what an extent adult health and mortality disparities across socioeconomic status (SES) are the product of attributes of the positions themselves, the partial result of health conditions established earlier in life that influence both adult health and economic success, or the outcome of the reverse impact of health status on SES. In the domain of social stratification, the transmission of inequalities across generations has been remarkably resistant to satisfactory explanations. Although the literature on social stratification is by and large silent about the role played by early health status in shaping adult socioeconomic opportunities, new research on human capital formation suggests this is a serious error of omission. In this paper we propose to investigate the connections between these two domains. We use data from male respondents of the 1958 British Cohort to estimate (a) the influence of early health conditions on adult SES and (b) the contribution of early health status to observed adult health differentials. The model incorporates early conditions as determinants of traits that enhance (inhibit) social mobility and also conventional and unconventional factors that affect adult health and socioeconomic status. Our findings reveal that early childhood health plays a small, but non-trivial role as a determinant of adult SES and the adult socioeconomic gradient in health. These findings enrich current explanations of SES inequalities and of adult health and mortality disparities. [ABSTRACT FROM AUTHOR]

Aim: To compare the haemodynamic status during high-frequency oscillatory ventilation and conventional mechanical ventilation in very preterm infants with respiratory distress syndrome.Methods: Thirty-two neonates of less than 30 wk gestation randomly assigned to high-frequency oscillatory ventilation (n = 15) or conventional mechanical ventilation (n = 17) had three echocardiographies and one cerebral Doppler-echography under the same ventilation during the first 48 h of life.Results: Mean airway pressure was 2 cm H2O higher in infants ventilated with high-frequency oscillatory ventilation at the different echocardiographies. Comparable right ventricular indexes were observed in the two groups. Reduction of the ductus arteriosus diameter and ductal closure were significant only in neonates ventilated conventionally. Left ventricular performance and left ventricular contractility did not differ between the groups. The high-frequency group had lower end diastolic velocity and a higher resistance index in the anterior cerebral artery.Conclusion: Compared with conventional mechanical ventilation, high-frequency oscillatory ventilation was achieved without altering cardiac function. However, the inability of the left ventricle to improve its performance in the presence of a significant ductal shunt suggests a narrow range of optimal pressures under this ventilatory mode. [ABSTRACT FROM AUTHOR]

Summary: Percutaneous suprapubic catheterization is an alternative when placement of a urethral catheter is contraindicated or unsuccessful. We report the case of a 3-day-old newborn, who presented anuric acute renal failure secondary to placement of a suprapubic catheter. An excessive length of catheter had been inserted into the bladder and was obstructing the vesicoureteral junctions. Several measures can be taken to prevent this complication, such as systematic measurement of the length inserted into the bladder, use of a catheter with 1cm gradations or recourse to radiopaque material. [Copyright &y& Elsevier]

Abstract: By now Lemierre''s syndrome is a seldom-described disease whose prognosis depends on the precocity of treatment. Case presentation: We report the case of an 11-month-old child, with a fulminant Fusobacterium necrophorum meningitis, which derived from a gingival infection, with fatal outcome. Conclusion: This atypical case of Lemierre''s syndrome (young age occurrence and localisation) underlines the potential severity of F. necrophorum sepsis. [Copyright &y& Elsevier]

Objectif La recherche de déficit immunitaire est conseillée en systématique devant une infection sévère mais peu réalisée en pratique. Nous avons analysé les hospitalisations pour infection sévère en réanimation pédiatrique au CHU de Montpellier afin de déterminer la proportion d’enfants présentant une anomalie immunitaire. Matériels et méthodes Furent inclus tous les patients âgés de 1 mois à 16 ans hospitalisés pour infection prouvée de juin 2013 à juin 2015. Étaient relevés : l’existence de comorbidité, la réalisation d’un dépistage immunitaire, la présence d’anomalies sur celui-ci. Résultats principaux Sur 876 hospitalisations, il y avait 19,7 % d’infections prouvées. Quatre-vingt-neuf enfants furent inclus dont 59 sans comorbidité. Les germes prédominants étaient les méningocoques (12 cas), les pneumocoques (9 cas) et les Rotavirus (7 cas). Trente-neuf pour cent des enfants sans comorbidité ont bénéficié d’un bilan immunitaire. Huit enfants (35 %) présentaient des anomalies sur leur bilan immunitaire. Les enfants porteurs de déficit immunitaire représentaient 27 % des inclus. Conclusion La proportion de déficit immunitaire est importante chez les enfants hospitalisés en réanimation pour infection ; la réalisation de bilans systématiques est nécessaire afin d’assurer un suivi adapté de ces enfants. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons le cas d’une adolescente de 14ans ayant présenté une hypokinésie ventriculaire gauche symptomatique dans les suites de la rupture d’une malformation artério-veineuse cérébelleuse. La cardiomyopathie de type tako-tsubo doit être connue des pédiatres, car les circonstances déclenchant l’affection, un facteur émotionnel ou une atteinte du système nerveux central, peuvent se rencontrer dans l’enfance. Elle est responsable d’une dysfonction ventriculaire qui prédomine à l’apex et dans la région médio-ventriculaire gauche, donnant un aspect caractéristique à l’échocardiographie. Un traitement symptomatique peut être transitoirement nécessaire en cas d’hypotension artérielle, de trouble du rythme ou d’insuffisance cardiaque. Son évolution généralement favorable autorise à délivrer une information rassurante et à limiter les explorations étiologiques sur le muscle cardiaque. [ABSTRACT FROM AUTHOR]

Summary: Introduction: The management of diarrhea-associated hemolytic and uremic syndrome (D+ HUS) with severe acute neurological involvement continues to be debated. We report on 2 cases and discuss the treatment. Case report 1: A 2.5-year-old girl presented with generalized seizures during gastroenteritis. Blood tests revealed features of HUS and a pyramidal syndrome was found on physical examination. Brain MRI, 24h after admission, showed lesions in the periventricular and subcortical area. She was started on peritoneal dialysis (PD) and daily plasma exchanges (PE) for 10 days. Her neurological condition improved quickly as well as the findings of the second brain MRI performed after PE. One year later she had no apparent neurological or renal sequelae. Case report 2: A 2.5-year-old boy presented with generalized seizures during gastroenteritis for 3 days, leading to a diagnosis of HUS. He also had a severe pyramidal syndrome with spastic tetraparesis and aphasia. Brain MRI, 48h after admission, revealed severe bilateral and symmetric lesions involving the thalami, internal and external capsules, lenticular nuclei, and brainstem. He was started on PD and daily PE for 10 days. Brain MRI performed after PE was unchanged. Clinically, his neurological condition improved slowly with regression of spastic tetraparesis and progressive recovery of motor skills. Nine months later, his renal function is normal but he is still having intensive physiotherapy. Discussion: Both children have received similar management including 10 PEs started within 48h after the diagnosis of D+ HUS with severe neurological involvement, but their neurological outcome appeared to be signicantly different. There is no clear proof in the literature concerning the effects of PE in such patients, even when performed very early. Eculizumab, an antibody that inhibits complement factor 5a and the formation of the membrane attack complex, has recently been used in such cases and seems to provide a more specific therapeutic action. Control studies are needed to specify its use in this disease. [Copyright &y& Elsevier]