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To relieve respiratory problems such as apnea in newborns, caffeine citrate is the drug of choice because of its good tolerance and therapeutic index. However, its impact on the intestinal microbial ecosystem and on bacterial translocation in the neonatal period remains insufficiently investigated. Therefore, the objective of this study was to evaluate the effects of caffeine citrate on the establishment of the intestinal microflora and bacterial translocation in rats from birth to the 30th day of life. Newborn Wistar rats were divided into four groups of 14 animals, each subdivided into a control group receiving a placebo (12mL tap water/kg/day) and another treated with caffeine citrate (12mg/kg/day). The animals were nursed by their mothers and weighed daily. A group of 14 rats was killed at birth and after 10, 20, or 30 days of life. Organs in which translocation was assessed (liver, lungs, spleen, and kidneys) and various fragments of intestine (duodenum, jejunum, ileum, and colon) were surgically removed. The bacteriological analysis performed involved enumeration of the total microflora, staphylococci, enterobacteria, and lactobacilli. From the 10th day, caffeine was shown to significantly decrease the weight of treated animals as compared with controls (P

Resume L’erythropoieine recombinante (EPOr) a montre un benefice en termes de reduction du nombre de transfusions chez les nouveau-nes de tres faible poids de naissance. L’objectif de cette etude etait d’evaluer l’efficacite de l’EPOr entre 30 et 32 semaines d’amenorrhee (SA). Methode Deux groupes ont ete compares dans une etude retrospective : de janvier 2005 a octobre 2006 enfants recevant de l’EPOr et de novembre 2006 a mai 2007 enfants sans EPOr. Etaient exclus, les enfants avec retard de croissance intra-uterin, allo-immunisation rhesus ou pathologie chirurgicale. Le critere principal de jugement etait le nombre de transfusion, les criteres secondaires les taux d’hemoglobine a 2, 4 et 6 semaines de vie. Les comorbidites ont ete evaluees sur les plans neurologique (hemorragie intraventriculaire, leucomalacie periventriculaire) et digestif (enterocolite ulceronecrosante). Resultats Cinquante-neuf nouveau-nes avec EPOr et 19 sans EPOr ont ete inclus. Les 2 groupes etaient comparables pour le poids (p = 0,06) et le taux d’hemoglobine de naissance (p = 0,41). Une seule transfusion etait relevee (groupe EPOr). Les taux d’hemoglobine a 2 semaines (p = 0,74), 4 semaines (p = 0,13) et 6 semaines de vie (p = 0,35) etaient similaires. Il n’existait pas de difference significative concernant les comorbidites entre les 2 groupes, tant sur le plan neurologique que digestif. Conclusion Cette etude retrospective ne met pas en evidence de benefice a traiter par EPOr les prematures de plus de 30 SA que ce soit en termes de nombre de transfusion ou de taux d’hemoglobine.

Neonatal renal venous thrombosis may result in severe morbidity. Predisposing conditions are well known. We report the case of an unusual and early neonatal renal venous thrombosis. The mother received an electrical shock at 34 weeks gestation. This case demonstrates that maternal electrical shock effect on the fetus should be early investigated.

Resume But de l’etude. – Identifier les modes de transmission et les facteurs de risque d’infection ou colonisation a Serratia marcescens productrice de betalactamase a spectre etendu (BLSE) constatee, en juin–juillet 2002, dans le service de reanimation pediatrique du CHU d’Amiens. Materiel et methodes. – L’etude porte sur 40 enfants, cinq cas (4 infections pulmonaires et 1 colonisation digestive) et 35 temoins. Les isolats de Serratia analyses proviennent de quatre aspirations bronchiques et d’une coproculture pour les cas, d’urine et de pus pour les deux souches de comparaison. Les autres donnees ont ete recueillies dans le dossier patient. Les analyses statistiques ont ete effectuees sur Epi-Info 6.04 dFr et SPSS 11.0.1. Resultats. – Le taux d’attaque des infections ou colonisations a S. marcescens BLSE est de 12,5 % [4,7–27,6] et l’incidence de 8,8 [6–11,6] pour 1000 journees d’hospitalisation. Les repartitions par âge, sexe, poids ou taux de naissances prematurees des cas et des temoins etaient comparables en analyse univariee. Les cas n’ont pas plus souvent eu d’actes invasifs mais ont ete intubes ( p p p S. marcescens BLSE est responsable des infections pulmonaires. Ce clone est different de ceux observes dans les selles voire d’autres prelevements. Conclusion. – Le defaut d’hygiene des mains et d’asepsie lors des instillations et/ou aspirations bronchiques sont les causes probables des contaminations croisees a S. marcescens BLSE . Le renforcement des regles d’hygiene ont permis de controler l’epidemie.

a chute de templirature interne observke a la naissance (jusqu’h 4,5 “C, [1]) et l’incapacite de frissonner, clui est un des ma thermiques de l’environnement.

A new heating unit (servocontrolled skin temperature derivative system) has been designed to control the thermal environment in closed incubators. This type of control acts to attain and closely maintain a thermal equilibrium between a neonate's skin temperature and the environment. The present study aims to discover if thermal equilibrium is located within a thermoneutral range defined from oxygen consumption (\(\dot V_{O_2 } \)) and body temperature, and whether it is more appropriate to define an optimal thermal environment. As regards\(\dot V_{O_2 } \) and body temperature, results show that the air temperature reached at thermal equilibrium fulfils the definition of thermoneutrality. According to these criteria, a small decrease (1.5°C) from thermal equilibrium also provides a near thermoneutral environment to the neonate but induces sleep disturbances and an increase in body movements. These two additional parameters delineate a narrower thermoneutral zone than does minimal metabolic rate because\(\dot V_{O_2 } \) can stay constant even when air and body temperatures decrease. The results suggest that thermal equilibrium might be assimilated with a thermal comfort zone.

Defining a thermoneutral environment remains difficult because thermoneutrality depends on both physical and physiological factors. A servocontrolled skin temperature derivative (SCS) heating device has been designed to control the thermal environment in closed incubators without the necessity of setting an air or skin reference temperature. The thermal environment obtained with the SCS program is controlled only by the neonate's skin temperature changes. For each neonate, the program allows the attainment of a specific individual thermal equilibrium (Teq). Although the mean value of the thermal equilibrium level measured on 29 neonates does not differ significantly from the neutral air temperature defined from the charts of other researchers, individual values of Teq differed greatly among neonates of similar birthweight and postnatal age. When compared with on/off heating programs, the SCS system permits greater quiet sleep occurrence and seems to provide an optimal thermal environment. The results suggest that the skin temperature derivative heating program takes into account both the ambient and physiological factors affecting body temperature regulation of each neonate.

L'evolution des explorations fonctionnelles respiratoires (EFR) chez des enfants atteints d'une dysplasie bronchopulmonaire (DBP) a court (avant 3 mois d'âge corrige) et a moyen terme (entre 3 et 9 mois d'âge corrige) est encore imparfaitement connue. Population et methodes. - Les resultats des EFR chez 22 prematures atteints de DBP (âge gestationnel = 31 ± 2,5 semaines d'amenorrhee ; poids de naissance = 1570 ± 440 g ; duree de ventilation artificielle = 46 ± 24 jours ; duree totale d'oxygenation = 88 ± 47 jours) ont ete compares a ceux obtenus chez 27 bebes temoins pour la premiere EFR et dix bebes temoins pour la deuxieme EFR. Il n'y avait pas de difference significative au niveau du poids et de l'indice de corpulence (IC) entre les patients et les enfants temoins. Resultats. - A la premiere EFR, les principales anomalies constatees par rapport au groupe de controle etaient une augmentation du volume gazeux thoracique (VGT) (165 ± 42 vs 122 ± 24 mL ; p < 0,001) et du rapport VGT/IC (1,25 ± 0,31 vs 0,89 ± 0,17 mL/kg/m 2 ; p < 0,0001), une baisse de la compliance pulmonaire (2,49 ± 1,46 vs 11,6 ± 4,50 mL/cmH 2 O ; p < 0,0001) et de la compliance pulmonaire specifique (0,015 ± 0,010 vs 0,100 ± 0,042 mL/cmH 2 O/mL de VGT ; p < 0,0001), une augmentation des resistances pulmonaires totales (20,4 ± 12,1 vs 10,5 ± 5,3 cmH 2 O/L/s ; p < 0,001). A la deuxieme EFR, une augmentation du VGT (235 ± 62 vs 166 ± 28 mL ; p < 0,01) et du rapport VGT/IC (1,64 ± 0,65 vs 0,98 ± 0,11 mL/kg/m 2 ; p < 0,05), une baisse de la compliance pulmonaire (2,68 ± 2,0 vs 15,1 ± 5,7 mL/cmH 2 O ; p < 0,001) et de la compliance pulmonaire specifique (0,013 ± 0,010 vs 1,106 ± 0,050 mL/cmH 2 O/mL de VGT ; p < 0,0001), une augmentation des resistances pulmonaires totales (17,1 ± 9,6 vs 8,6 ± 4,9 cmH 2 O/L/s ; p < 0,05) ont ete trouvees par rapport au groupe controle. Les principales anomalies au niveau des gaz du sang etaient une hypoxie (63 ± 10 vs 85 ± 20 mmHg ; p < 0,0001) et une hypercapnie (38,5 vs 31 ± 4 mmHg ; p < 0,0001) a la premiere EFR. A la deuxieme EFR, l'hypoxie (77 ± 14 vs 90 ± 14 mmHg ; p < 0,05) et l'hypercapnie (37 ± 4 vs 29 ± 5 mmHg ; p < 0,0001) persistaient. Chez les enfants atteints de DBP, la distension thoracique et les resistances pulmonaires totales ne s'amelioraient pas d'une EFR a l'autre, alors qu'une amelioration au niveau de la compliance pulmonaire (p < 0,0001) et de la PaO 2 (p < 0,01) etait notee. Les enfants qui ont ete ventiles pour une maladie des membranes hyalines (MMH) etaient plus hypoxiques a la deuxieme EFR que ceux qui ont ete ventiles pour d'autres pathologies (p < 0,05). Il existait des relations statistiquement significatives entre la distension thoracique et la duree de l'agression barometrique par pression positive inspiratoire (p < 0,05 ; r = 0,43), par pression positive expiratoire (p < 0,05 ; r = 0,45), la duree d'oxygenotherapie (p < 0,05 ; r = 0,55) ; entre les resistances pulmonaires totales et la duree d'une ventilation artificielle a frequence elevee (p < 0,05 ; r = 0,52) ; entre l'hypoxemie et la duree de l'oxygenotherapie a FiO 2 ≥ 60 % (p < 0,05 ; r = 0,54). Conclusion. - Dans cette population de 22 prematures atteints de DBP, il existe encore des troubles respiratoires vers l'âge de 9 mois d'âge conge, associes a des perturbations prolongees des EFR.

Thermoregulation in newborn infant differs from that of adult. Comparisons between sleep stages show that, during rapid eye movements (REM) sleep, the impairment of thermoregulatory responses in adult is not observed in newborn. Both behavioral and autonomic temperature regulations are always operative in the range of air temperatures usually imposed. The interaction between sleep and thermoregulation seems to be less important in newborns than in adults, suggesting that sleep processes are well protected, reducing the probability of occurrence of central dysfunction. According to the model describing thermoregulation during sleep on the basis of changes in the hierarchical dominance of brain structures, either the influence of diencephalic structures is never depressed in REM sleep or the functional autonomy of the rhombencephalon is still relevant in the immature encephalon of the newborn. The thermoregulatory model also allows understanding of inter-individual differences in thermoregulation and levels of thermoneutrality. An attempt has also been made to learn the role of heat stroke in the production of sudden infant death syndrome when body heat loss is hampered.

Background.- Definitive diagnosis of a neonatal infection usually requires recovery of an etiologic agent from body fluids or tissues such as spinal fluid, blood and urine. Routine lumbar puncture (LP) may raise some problems in interpreting results. Population and methods.- A retrospective analysis of 1331 samples of CSF was made. LP had been performed on 1041 neonates including 569 prematures (54.6%) as a part of the evaluation for suspected bacterial infection. Results.- In 50.7% of the cases, the CSF was haemorrhagic. The frequency of traumatic taps increased with the degree of prematurity, low birth weight, precocity of LP, association with respiratory distress and disorders of coagulating factors. In addition, haemorragic taps modified biochemical and cytologic characteristics of CSF. One hundred and six (8%) CSF samples contained organisms but the diagnosis of meningitis was certain in only 23 cases (2.2%). In the other 83 cases, CSF was thought to be contaminated, mostly by coagulase-negative staphylococci. Since both blood and CSF cultures were positive for the same bacterial organism in 18 cases, it was concluded that the LP had been useful in identifying the pathogens in only five cases. The high frequency of contaminated CSF led to overestimation of the incidence of true bacterial meningitis (0.57% in our study). Conclusions.- The low incidence of meningitis in neonates, the risk of having an haemorragic tap associated with the possibility of clinical aggravation during LP and the fact that the same pathogen is frequently (78.2% of cases) identified in blood cultures suggest that the immediate and routine LP is of less value than expected in infants suspected to be infected. LP could be postponed when the neonate presents with a respiratory distress syndrome and/or a precarious haemodynamic state.

Habituellement, dans une demarche diagnostique, les medecins utilisent des liens probabilistes entre les symptomes et les maladies auxquelles ils affectent un facteur de certitude. La puissance d'un lien depend de l'apprentissage que le medecin a recu, de son vecu par rapport a la maladie, ainsi que de son experience: les medecins issus d'une meme faculte ou d'un meme pays evoquent souvent les memes diagnostics. Cette procedure est tres efficace quand il n'y a pas trop de diagnostics possibles, ou qu'un diagnostic a une forte probabilite. Elle est egalement tres efficace dans l'urgence, car elle permet de prendre des decisions rapides et d'appliquer une therapeutique appropriee.

Neonatal compartment syndrome is rare, and the diagnosis is often missed or delayed because other ischemic diseases can mimic clinical signs observed on the skin. A premature newborn infant presented with skin lesions during the first hours of life that were recognized as the sentinel finding in compartment syndrome of the newborn. We restored normal function by emergency surgery. The authors highlight the importance of effective collaboration between pediatricians and surgeons to improve the management of this neonatal condition.

To relieve respiratory problems such as apnea in newborns, caffeine citrate is the drug of choice because of its good tolerance and therapeutic index. However, its impact on the intestinal microbial ecosystem and on bacterial translocation in the neonatal period remains insufficiently investigated. Therefore, the objective of this study was to evaluate the effects of caffeine citrate on the establishment of the intestinal microflora and bacterial translocation in rats from birth to the 30th day of life. Newborn Wistar rats were divided into four groups of 14 animals, each subdivided into a control group receiving a placebo (12mL tap water/kg/day) and another treated with caffeine citrate (12mg/kg/day). The animals were nursed by their mothers and weighed daily. A group of 14 rats was killed at birth and after 10, 20, or 30 days of life. Organs in which translocation was assessed (liver, lungs, spleen, and kidneys) and various fragments of intestine (duodenum, jejunum, ileum, and colon) were surgically removed. The bacteriological analysis performed involved enumeration of the total microflora, staphylococci, enterobacteria, and lactobacilli. From the 10th day, caffeine was shown to significantly decrease the weight of treated animals as compared with controls (P0.05). However, caffeine treatment did not drastically alter the kinetics of establishment of the intestinal microflora as only enterobacteria were found to be significantly lower in any intestinal segment of the treated group (P0.05). Moreover, from the 20th day of life, caffeine citrate significantly downregulated bacterial translocation of both Gram-positive and -negative bacteria (P0.05). This preliminary study on the effects of treatment with caffeine citrate may open opportunities in clinical pediatrics; the treatment will remain partially effective in preventing bacterial translocation in the neonatal period.

Human recombinant erythropoietin (rhEPO) has shown a benefit in reducing the number of transfusions in very-low-birth-weight infants. However, no study has reported benefits in older preterms (i.e., 30-32 weeks of gestation [WG]). This study aimed to evaluate the benefit of rhEPO between 30 and 32 WG.Two groups of preterms between 30 and 32 WG were compared in a retrospective study: period 1 with rhEPO (January 2005 to October 2006) and period 2 without rhEPO (November 2006 to May 2007). Newborns with intra-uterine growth retardation, rhesus isoimmunization or surgical procedures were excluded. The main criterion was the number of blood transfusions; the second criterion was hemoglobin at 2, 4 and 6 weeks of life. Morbidity was evaluated on necrotizing enterocolitis, intraventricular hemorrhage (IVH) and periventricular leukomalacia.Fifty-nine newborns receiving rhEPO and 19 not receiving rhEPO (controls) were included. The two groups were similar for birth weight (p=0.06) and hemoglobin at birth (p=0.41). Only one child (rhEPO group) needed a transfusion. Hemoglobin at 2 weeks (p=0.74), 4 weeks (p=0.13) and 6 weeks (p=0.35) were not statistically different. There was no difference between the 2 groups for necrotizing enterocolitis, IVH or periventricular leukomalacia.This study did not find any benefit using rhEPO in 30 to 32 WG preterm infants in terms of the number of transfusions or hemoglobin levels.

Persistent pulmonary hypertension of the newborn (PPHN) occurs in 1-4% of neonates with transposition of the great arteries with intact ventricular septum (TGA/IVS). This association is often lethal. To our knowledge, only eight survivors have been described in the literature, two of whom benefited from extracorporeal membrane oxygenation (ECMO). We report two cases of PPHN complicating a TGA/IVS that were refractory to multiple therapies and resolved 48 hours after initiation of bosentan therapy. Bosentan, an oral dual endothelin-1 receptor antagonist, is a new treatment for pulmonary arterial hypertension that was both effective and safe in these two cases of TGA/IVS with PPHN. To our knowledge, it is the first use of bosentan in newborns.

To identify patient-related risk factors of infection and ways of transmission of extended-spectrum betalactamase (ESBL) producing Serratia marcescens in the paediatric intensive care unit (PICU) of Amiens university hospital (France) between June and July 2002.Five cases (four pulmonary infected and one stool contaminated symptom-free neonates) and 35 controls, admitted in the PICU, are included. S. marcescens ESBL analysed are isolated from respiratory tract and faecal samples for cases and urine and pus samples from two non-paediatric other patients. Univariate and multivariate analysis are performed on EPI INFO 6.04 dFr and SPSS 11.0.1.S. marcescens ESBL infections or colonisations rate is 12.5% [4.7-27.6]. The incidence is 8.8 [6.7-11.6] per 1000 hospital-stay days. By univariate analysis, cases and controls don't differ with respect of age, sex, and weight at admission or preterm delivery. Cases don't have more often invasive nursing care than controls. But, they were intubated (P0.03) and hospitalised (P0.03) for a longer time than controls. Linear regression analysis showed that duration of intubation was independent predictor of acquisition of S. marcescens ESBL (P0.008). S. marcescens ESBL strains implicated in pulmonary infections, showed the same pattern of multidrug resistant and ERIC-PCR profile. This clone differs from others isolated from stool or other samples from other hospital wards.As S. marcescens cross-colonization appears to be due to lake of hand hygiene and asepsis during invasive nursing care, reinforcing hygiene measures permit to contain the outbreak.

Neonatal renal venous thrombosis may result in severe morbidity. Predisposing conditions are well known. We report the case of an unusual and early neonatal renal venous thrombosis. The mother received an electrical shock at 34 weeks gestation. This case demonstrates that maternal electrical shock effect on the fetus should be early investigated.

The present study aimed at comparing two techniques which measure lung transfer factor for carbon monoxide (TL/sub CO/) in infants. The gold standard deals with the Fick mass-balance applied when steady state for ventilation and CO gas fractions is achieved. The second technique models CO uptake in dynamic conditions where gas fractions are changed by a rebreathing maneuver. This procedure increases inspired CO/sub 2/ fraction and decreases that of O/sub 2/ that can change the ventilation. Our goal was to test whether the changing ventilation biases TL/sub CO/ accuracy. The experimental setup includes a fast respiratory valve suitable to infants (low dead-space and short time response) which switches the ventilation from air to a Douglas bag. Eight infants (age: 1-5 months; body mass: 2.2-8.2 kg) participated to the study. Results show a strong correlation between the two methods determining TL/sub CO/ and no significant difference in the magnitudes of this parameter TL/sub COdyn/=0.18/spl plusmn/0.02 and TL/sub COss/=0.19/spl plusmn/0.04 mmol/min/kPa/kg; r=0.95. TL/sub COdyn/ accuracy is not modified by the changes in CO/sub 2/ and O/sub 2/. As the test requires signal recordings of only 30 s duration, we recommend the rebreathing maneuver which shortens the test duration.

Helium dilution maneuver is used to determine the functional residual capacity (FRC) 14 newborns ages 1-5 mo. The model equation describes the changing alveolar fractions of He and the ventilation promoted by a rebreathing procedure that does not exceed 40 s. The model does not involve the volume of the rebreathing bag usually needed when applying rebreathing technique and which is a source of error. The equation is discretized and solved for recorded data obtained with equipment adapted to newborns. Results show a strong relationship between FRC and the biometrical indexes, and confirm these found in the literature featuring that the measurement duration of FRC can be considerably shortened.

Between January 1997 and June 1999, we screened for hearing loss using evoked otoacoustic emissions in 320 newborns in the neonate intensive care unit at the Amiens University Hospital. The purpose of this study was to search for correlations between deafness and one of the hearing loss risk factors identified by the Joint Committee on Infant Screening. Three risk factors were found to be significant: craniofacial abnormalities, low birth weight (less than 1500 g) and a familial history of hearing loss. Unfortunately a large proportion of the infants were lost to follow-up. Evoked otoacoustic emission provide an excellent screening technique for hearing loss in newborns. Such screening implies however the creation of networks to assure patient follow-up.

Objectifs Evaluer l’impact de la mise en place de puericultrices dediees aux transports infirmiers inter hospitaliers (T2IH) pediatriques sur l’occupation de la seule reanimation neonatal regional de niveau III. Materiel et Methode Etude retrospective comparant les periodes [2002–2005] (avant) et [2006–2009] (apres la mise en place de T2IH pediatriques). Pour chaque periode, l’occupation de la reanimation neonatale etait analysee. Resultats Les T2IH pediatriques ont permis d’assurer 334 ± 36 transports/an pour la periode [2006–2009]. Aucun incident significatif n’etait rapporte. En parallele, on observait une diminution de la duree moyenne de sejour (DMS) en reanimation neonatale ([2002–2005] : 10,6 ± 0,5 vs [2006–2009] : 9,0 ± 0,5 j, p p Discussion Meme si l’apport de T2IH pediatriques n’est qu’un des nombreux elements pouvant influencer la DMS, il contribue a un rapprochement familial dans les meilleurs delais. L’utilisation de materiel dedie, de personnel specialise (puericultrices) et de protocoles strictes permet d’assurer le transport de nouveau-ne, en particuliers prematures, avec une securite optimale.

Dynamic modeling of lung C/sup 18/O diffusion is used to measure the C/sup 18/O transfer factor (TL/sub co/) of 14 newborns aged 1-4 mo. The model equation is based on the alveolar fractions of C/sup 18/O and on changing alveolar ventilation induced by the rebreathing conditions. The model does not involve the volume of the rebreathing bag which is usually needed when applying rebreathing technique add which is a source of error. The equation is discretized and solved for recorded data obtained with equipment adapted to use in newborns. A least-square parameter calculation technique is applied to estimate TL/sub co/. Results show a strong relationship between this index and the biometrical ones and confirm those found in the literature featuring that the measurement duration can be considerably shortened.

Reports of short- and medium-term evolution of Lung Function Tests (LFT) in infants with bronchopulmonary dysplasia (BPD) are still scarce.The results of the first (before 3 months of corrected age) and the second (between 3 and 9 months of corrected age) LFT in 22 premature infants with BPD (gestational age 31 +/- 2.5 weeks; birth weight: 1570 +/- 440 g; duration of mechanical ventilation: 46 +/- 24 days, total duration of oxygen therapy: 88 +/- 47 days) were compared to those obtained in 27 normal infants for the first LEF and 10 normal infants for the second LFT, similar to the patients for birth weight and corporeal index (CI).In the first LFT, major abnormalities were an increased thoracic gaz volume (TGV) (16.5 +/- 42 vs 122 +/- 24 mL; P0.001) and TGV CI ratio (1.25 +/- 0.31 vs 0.89 +/- 0.17 ml/kg/m2; P0.0001) a decreased pulmonary compliance (2.49 +/- 1.46 vs 11.60 +/- 4.50 mL/cmH2O; P0.0001) and specific pulmonary compliance (0.015 +/- 0.10 vs 0.100 +/- 0.042 mL/cmH2O/mL de TGV; P0.0001), an increased total pulmonary resistance (20.4 +/- 12.1 vs 10.5 +/- 5.3 cmH2O/L/s; P0.001). In the second LFT, an increased TGV (235 +/- 62 vs 166 +/- 28 mL; P0.01) and TGV CI ratio (1.64 +/- 0.65 vs 0.98 +/- 0.11 ml/kg/m2; P0.05), a decreased pulmonary compliance (2.68 +/- 2.0 vs 15.2 +/- 5.7 mL/cmH2O; P0.0001) and specific pulmonary compliance (0.013 +/- 0.010 vs 0.106 +/- 0.050 mL/cmH2O/mL de TGV; P0.0001), an increased total pulmonary resistance (17.1 +/- 9.6 vs 8.6 +/- 4.9 cmH2O/L/s; P0.05) were noted when compared with the control group results. Major abnormalities of the blood gases were hypoxemia (63 +/- 10 vs 85 +/- 20 mmHg; P0.05), hypercapnia (38.5 vs 31 +/- 4 mmHg; P0.0001) during the first LFT. Hypoxemia (77 +/- 14 vs 90 +/- 14 mmHg and hypercapnia (37 +/- 4 vs 29 +/- 5 mmHg) continued in the second LFT. Thoracic distention and total pulmonary resistances in infants with BPD did not improve but their pulmonary compliance (P0.0001) and PaO2 (P0.01) between the first and second LFT did it. Infants who had been ventilated for a hyaline membrane disease (HMD) were more hypoxic on the second LFT (P0.05) than those who had been ventilated for other causes. Statistically significant relationships were found between thoracic distention and duration of positive inspiratory pressure (P0.05; r = 0.43), duration of positive expiratory pressure (P0.05, r = 0.45) total oxygen therapy duration; between total pulmonary resistance and duration of mechanical ventilation with high frequency (P0.05; r = 0.52); between hypoxemia and duration of oxygen therapy with FiO2or = 60% (P0.05; r = 0.54).This study shows prolonged clinical and functional abnormalities of the respiratory functions requiring longer follow-up.

Definitive diagnosis of a neonatal infection usually requires recovery of an etiologic agent from body fluids or tissues such as spinal fluid, blood and urine. Routine lumbar puncture (LP) may raise some problems in interpreting results.A retrospective analysis of 1331 samples of CSF was made. LP had been performed on 1041 neonates including 569 prematures (54.6%) as a part of the evaluation for suspected bacterial infection.In 50.7% of the cases, the CSF was haemorrhagic. The frequency of traumatic taps increased with the degree of prematurity, low birth weight, precocity of LP, association with respiratory distress and disorders of coagulating factors. In addition, haemorragic taps modified biochemical and cytologic characteristics of CSF. One hundred and six (8%) CSF samples contained organisms but the diagnosis of meningitis was certain in only 23 cases (2.2%). In the other 83 cases, CSF was thought to be contaminated, mostly by coagulase-negative staphylococci. Since both blood and CSF cultures were positive for the same bacterial organism in 18 cases, it was concluded that the LP had been useful in identifying the pathogens in only five cases. The high frequency of contaminated CSF led to overestimation of the incidence of true bacterial meningitis (0.57% in our study).The low incidence of meningitis in neonates, the risk of having an haemorragic tap associated with the possibility of clinical aggravation during LP and the fact that the same pathogen is frequently (78.2% of cases) identified in blood cultures suggest that the immediate and routine LP is of less value than expected in infants suspected to be infected. LP could be postponed when the neonate presents with a respiratory distress syndrome and/or a precarious haemodynamic state.

Objectif Determiner l’incidence et les caracteristiques des NRS hospitalises au cours d’une bronchiolite en reanimation au CHU d’Amiens (2008-2009). Materiel et Methode Recueil des donnees dans les dossiers d’hospitalisation des patients. Resultats (mediane (extremes)) 37 NRS d’âge 36j (9-196), de poids 3,5 kg (1,8-10) ont ete admis pendant la periode automno-hivernale (84%). Antecedents : AG 38SA (28-41), PN 2,8 kg (0,8-4,4), prematurite ( n = 9), cardiopathie ( n = 3), DBP ( n = 1). Signes respiratoires ( n = 36): tirage, cyanose, pauses respiratoires; S. digestifs ( n = 23): refus alimentaire, vomissements, diarrhee; S. generaux : fievre ( n = 15), hypotension arterielle ( n = 11); S. neurologiques ( n = 6): convulsions, alteration de la conscience. Micro-organismes : virus ( n = 35): VRS ( n = 26), Parainfluenzae 3 ( n = 5), Metapneumovirus ( n = 4); bacteries ( n = 17): S. pneumoniae ( n = 7), B.catarrhalis ( n = 4), H. influenzae ( n = 2), autres ( n = 4). Assistance respiratoire (n; duree): O2 nasale (24; 2j (1-69)), VNI (13; 2j (1-11)), ventilation tracheale (12; 3,5j (1-12)), OHF (3; 2j (1-4)), monoxyde d’azote ( n = 2). Duree de sejour: 4j (1-69). Evolution: 2 deces. Conclusion Le sejour en reanimation concerne les cas de bronchiolite a VRS avec surinfection bacterienne, essentiellement chez le nourrisson de moins de 2 mois.

Introduction ICMV peut etre associee a des complications graves. Le diagnostic est rendu difficile meme dans les formes symptomatiques (10 %) a cause de la grande variabilite du tableau clinique. Objectif Etudier les caracteristiques cliniques, biologiques et evolutives des formes symptomatiques de ICMV. Materiel et Methode : Analyse de dossiers de nouveau-nes avec ICMV, hospitalises en soins intensifs et reanimation neonatale du CHU d’Amiens (Juillet 2008-Fevrier 2010). Resultats Six cas de ICMV diagnostiques. Signes cliniques : ictere ( n = 6), RCIU ( n = 4), microcalcifications cerebrales ( n = 4), prematurite ( n = 3), microcephalie ( n = 3), petechies ( n = 3) pneumopathie hypoxemiante ( n = 2), splenomegalie ( n = 2), chorioretinite ( n = 2), microphtalmie ( n = 1). Signes biologiques thrombopenie ( n = 6), cytolyse hepatique ( n = 5), cholestase ( n = 4) Diagnostic virologique: virurie ( n = 6), PCR+ dans le sang ( n = 4) et secretions tracheales ( n = 2). Traitement ganciclovir ( n = 4) Evolution cecite ( n = 1), surdite (n = 1), emphyseme pulmonaire ( n = 2), deces ( n = 2). Conclusion La mise en evidence de RCIU, d’atteinte hepatique, de thrombopenie et de microcalcifications cerebrales chez le nouveau-ne doit conduire a la realisation d’une virurie afin de ne pas meconnaitre une infection a CMV et d’eviter tout retard au traitement.

Les flavonoides ont un interet sur la sante. Objectif Etudier l’effet de flavonoides naturels et synthetisees sur des probiotiques et pathogenes en mesurant l’auto et la coagregation. Materiels et Methodes L’effet prebiotique des flavonoides a ete etudie sur deux probiotiques Lactobacillus. rhamnosus et Streptococcus thermophilus isolees. L’activite antibacterienne a ete evaluee sur des pathogenes Staphylococcus aureus et Escherichia coli. Resultats Tous les flavonoides ont montre une activite prebiotique significative par la croissance des probiotiques et en inhibant les pathogenes. Ainsi, ils ont un effet stimulateur sur l’agregation des probiotiques, qui varie de 80 % a 98 % pour Lactobacillus rhamnosus et de 68 % a74 % pour Streptococcus thermophilus. La coagregation a ete amelioree, et varie entre 72 % a 92 %. La coagregation de probiotique-pathogene, est amelioree en presence des deux flavonoides. Conclusion Les deux flavonoides ont prouve leur role prebiotique et ont un effet sur l’agregation des bacteries. Ces molecules pourraient etre utilises comme agents alternatifs ou additifs pour ameliorer la croissance des bacteries probiotiques et de prevenir la colonisation des bacteries pathogenes.

Objectifs Chez le nouveau-ne premature, l’erythropoiese ne peut etre assuree correctement par les taux d’erythropoietine circulants, entrainant une anemie dans les premieres semaines de vie. Un traitement prophylactique par erythropoietine recombinante (EPOr) est habituellement propose chez les prematures Methodes Deux periodes etaient compares : [janvier 2005 – octobre 2006] ou tous les prematures de 30 a 32 SA recevaient de l’EPOr puis [novembre 2006 – mai 2007] ou ils n’en recevaient pas. Les prematures presentant un retard de croissance intra-uterin, une allo-immunisation ou necessitant une pathologie chirurgicale etaient exclus. Le critere principal etait le nombre de transfusion ; les criteres secondaires, les taux d’hemoglobine (Hb) a la naissance, a 2 et 4 semaines de vie et avant le retour a domicile. La morbidite etait evaluee sur les anomalies a l’echographie transfontanellaire et la survenue d’enterocolite ulcero-necrosante (ECUN). Resultats 78 prematures etaient inclus : 59 EPOr et 19 temoins (T). Les deux groupes etaient comparables pour le poids (EPOr : 1470 ± 181 vs. T : 1545 ± 139 g ; p = 0.10) et l’Hb de naissance (EPOr : 16 ± 2,7 vs. T : 16,5 2 g/dL ; p = 0,41). Un seul enfant necessitait une transfusion (groupe EPO). L’Hb a 2 semaines (EPOr : 14,2 ± 1,9 vs. T : 14,4 ± 1,9 g/dL ; p = 0,85), 4 semaines (EPOr : 12.9 ± 2.4 vs.T : 12.6 ± 3,1 g/dL ; p = 0.75) et a la sortie (EPOr : 11.85 ± 2.2° vs T : 11.3 ± 2.7 g/dL ; p = 0.35) n’etaient pas differents. Il n’existait pas de difference entre les deux groupes tant pour la survenue d’une hemorragie intra-ventriculaire (EPOr : 6 vs T : 2 ; p = 0,92) que d’une leucomalacie periventriculaire (EPOr : 3 vs T : 2 ; p = 0,51) ou d’une ECUN (EPOr : 3 vs T : 0 ; p = 0.31). Conclusion Nous n’avons pas mis en evidence de benefice a l’utilisation de l’EPOr chez les prematures de 30 a 32 SA. Ce traitement etant a la fois douloureux et d’un cout eleve, il semble que les methodes actuelles d’epargne sanguine (limitation des prelevements sanguins, micro-methodes) soient a privilegier dans cette population.

Objectifs L’oxygenotherapie en lunette chez le nouveau-ne en detresse respiratoire moderee est utilisee en unites de neonatalogie et transports. La fraction inspiree en oxygene intra pulmonaire reelle (FiO2-Ip) est cependant difficile a evaluer. Le but de ce travail etait de quantifier sur un modele de poumon artificiel, la FiO2-Ip en fonction des parametres ventilatoires du nouveau-ne lors de variations de debit d’O2 (QO2), delivree par lunettes nasales. Materiels et Methodes Le modele ventilatoire comportait deux ballons elastiques (poumons), une boite hermetique (cage thoracique) et l’administration d’une pression negative intermittente simulant une respiration spontanee. L’O2 etait delivre par lunettes nasales. La FiO2-Ip etait mesuree pour differents parametres ventilatoires dans la gamme d’un nouveau-ne a terme et pour differents QO2 (0.5 – 5.0 L. min−1). Les resultats ont ete analyses en regressions lineaires simple et multivariee. Resultats La FiO2-Ip mediane etait elevee,avec des variations importantes selon les parametres ventilatoires pour un QO2 donne : FiO2-Ip mediane : 42 %, [extremes : 32 %-61 %], pour QO2 = 0.5 L. min−1. Un plateau apparaissait des QO2 = 4 L. min−1 (FiO2-Ip : 100 %). En analyse univariee, FiO2-Ip etait correlee au QO2 (p En regression multivariee seuls le QO2 (p Conclusion Malgre une grande variabilite, principalement liee au debit inspiratoire, la FiO2-Ip etait elevee pour un debit d’O2 en lunette faibles. Ce dernier ne devrait donc pas etre utilise comme marqueur de severite de la pathologie du nouveau-ne : un debit d’O2 faible en lunette pouvant s’associer a des besoins en oxygene importants et a une detresse respiratoire severe. Ces resultats incitent a rester attentifs au contexte et a l’evolution clinique pour adapter l’oxygenotherapie et la prise en charge du nouveau-ne.

Introduction Le transport neonatal en incubateur est un facteur de stress chez le nouveau-ne, en particulier premature. Le SMUR pediatrique regional d’Amiens a enregistre en 2006 pres de 600 transports de jour effectues en ambulance. Chez l’adulte, l’exposition aux vibrations peut avoir un impact direct sur la sante, allant de l’inconfort au retentissement pathologique. Le niveau de vibration est fonction de nombreux facteurs tels que l’incubateur, son environnement interne (type de matelas notamment), mais egalement du vehicule utilise. Objectif Le but de cette etude etait de comparer le niveau de vibration, auquel le premature est expose, selon deux types d’ambulance. Materiel et Methodes Les vibrations ont ete mesurees sous un mannequin simulant un premature, place sur un matelas en gel visqueux dans un incubateur NITE, Mediprema ® . Les vibrations ont ete mesurees avec un accelerometre triaxial. Les ambulances utilisees etaient pour l’une equipee d’une cabine integree au châssis (AR2) et pour l’autre d’une cabine posee sur châssis (AR4). Pour standardiser l’etude, les mesures (AR2 = 7, AR4 = 6) ont ete realisees lors d’un trajet extra urbain a vitesse constante (90 km/h) sur une distance de 11,5 Km. Resultats L’acceleration equivalente ponderee, obtenue avec l’ambulance AR2 (0,49 ± 0,07 m. s–2) est significativement inferieure (p Conclusion Les niveaux de vibrations moyens mesures sont variables en fonction du vehicule utilise et peuvent etre consideres de « legerement inconfortable » (AR2) a « assez inconfortable » (AR4) d’apres la norme ISO 2631-1.

The authors treated two groups of children in Zaire with two different regimens: chloroquine vs chloroquine-spiramycin. Chloroquine alone was successful in 83% of cases and chloroquine-spiramycin in 95% of cases (statistically significant). The tolerance of both regimens was excellent.

The authors present a standardization of the oculocardiac reflex carried out in early-age infants (under 3 months). This standardization is easy to perform. It takes into account the fall of the cardiac frequency, the asystoly and the range of bradycardia until its normalisation. Thus, it allows inter or intra individual comparison and can be applied to the study of infants at risk for sudden infant death syndrome.

Objectifs Apport de l’IRM 3 Tesla dans la mise en place d’un protocole rapide d’investigation des flux cerebraux de l’enfant. Materiels et methodes Les flux cerebraux du sang et du LCS ont ete mesures par contraste de phase sur une IRM 3 Tesla (GE Healthcare HDX) chez 14 enfants (âge : 13 jours a Sans), adresses pour bilan de differents troubles neurologiques. Les flux du LCS et du sang ont ete mesures au niveau rachidien et intracrânien. Le protocole de flux n’augmente le temps global de l’examen que de 5 min. Resultats Les oscillations du LCS dans l’aqueduc du tnesencephale et les espaces sous-arachnoidiens sont bien apprehendes, presentent des amplitudes variables en fonction de l’âge mais conservent un meme decours temporel. Le blocage de l’ecoulement du LCS a ete mis en evidence dans 2 cas d’hemorragie intra-ventriculaire. Dans un cas d’hydrocephalie traitee par ventriculocisternostomie, l’IRM de flux a permis d’affirmer sa bonne fonctionnalite. Conclusion La mesure des oscillations du flux sanguin et du LCS chez le nouveau-ne et l’enfant est realisable rapidement. Comme pour l’adulte, la determination des valeurs normales en fonction de l’âge necessitera l’exploration d’une grande cohorte.

Many studies have established that nosocomial infection rates are more important in intensive care units (ICU). The objective of the study was to evaluate frequency and severity of imported and acquired nosocomial bacteremia in the different ICU of a teaching hospital in relation to bacteremia occurring in the entire hospital.