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The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.

Informed by a series of systematic reviews, scoping reviews and evidence updates from the International Liaison Committee on Resuscitation, the 2021 European Resuscitation Council Guidelines present the most up to date evidence-based guidelines for the practice of resuscitation across Europe. The guidelines cover the epidemiology of cardiac arrest; the role that systems play in saving lives, adult basic life support, adult advanced life support, resuscitation in special circumstances, post resuscitation care, first aid, neonatal life support, paediatric life support, ethics and education.

This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: systematic reviews, scoping reviews, and evidence updates. Per agreement with the evidence evaluation recommendations of the International Liaison Committee on Resuscitation, only systematic reviews could result in a new or revised treatment recommendation. Systematic reviews performed for this 2020 CoSTR for pediatric life support included the topics of sequencing of airway-breaths-compressions versus compressions-airway-breaths in the delivery of pediatric basic life support, the initial timing and dose intervals for epinephrine administration during resuscitation, and the targets for oxygen and carbon dioxide levels in pediatric patients after return of spontaneous circulation. The most controversial topics included the initial timing and dose intervals of epinephrine administration (new treatment recommendations were made) and the administration of fluid for infants and children with septic shock (this latter topic was evaluated by evidence update). All evidence reviews identified the paucity of pediatric data and the need for more research involving resuscitation of infants and children.

Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person's presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.

To investigate the clinical, laboratory, electrophysiological, and imaging features associated with death or neurological impairment at 1 year of age in term neonates with hypoxic-ischemic encephalopathy (HIE) treated by therapeutic hypothermia (TH).This was a single-center retrospective and descriptive study conducted over a period of 2 years. We included consecutive term newborns with moderate or severe HIE who were treated by TH initiated within the sixth hour after birth and continued for 72 h,. For all patients, brain magnetic resonance imaging (MRI) was performed before the eighth day and a score was established; furthermore, at least two electroencephalograms were recorded.Among the 33 patients included, 20 neonates had a favorable outcome and 13 had an unfavorable outcome. Early clinical seizures (15% vs. 53.8%, p = 0.047), the persistence of a poor prognosis according to the electroencephalogram pattern after TH (0% vs. 69.2%, p = 0.0001), and an elevated score on the early brain MRI (2 vs. 11, p 0.001) combined with a high lactate/N-acetyl-aspartate ratio (0.52 vs. 1.33, p = 0.008) on spectroscopy were associated with death and a poor outcome.A combination of tools can help the medical team to establish the most reliable prognosis for these full-term neonates, to guide care, and to inform parents most appropriately and sincerely.

Resume En 2005, le Groupe francophone de reanimation et d’urgences pediatriques (GFRUP) publiait des recommandations concernant les limitations et arrets des traitements (LAT) en reanimation pediatrique. Depuis cette date, le Code de sante publique (CSP), modifie par les lois de 2005 et 2016 et leurs decrets d’application, est venu encadrer ces pratiques. Quinze ans apres leur parution, ces recommandations necessitaient d’etre actualisees pour tenir compte de l’experience acquise par les equipes, des nouvelles questions soulevees par des etudes de pratique, des recommandations parues dans l’intervalle, ainsi que des evolutions legislatives et des rares jurisprudences. Ce texte a pour objectif d’aider les equipes de reanimation pediatrique a conjuguer l’ethique de la prise en charge de l’enfant, de sa famille et le respect des dispositions reglementaires actuelles.

International audience

International audience; In 2005, the French-speaking task force on pediatric critical and emergency care [Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP)] issued recommendations on withholding and withdrawing treatments in pediatric critical care. Since then, the French Public Health Code, modified by the laws passed in 2005 and 2016 and by their enactment decrees, has established a legal framework for practice. Now, 15 years later, an update of these recommendations was needed to factor in the experience acquired by healthcare teams, new questions raised by practice surveys, the recommendations issued in the interval, the changes in legislation, and a few legal precedents. The objective of this article is to help pediatric critical care teams find the closest possible compromise between the ethical principles guiding the care offered to the child and the family and compliance with current regulations and laws.

These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.

The measured nitrogen-to-carbon ratio in comets is lower than for the Sun, a discrepancy which could be alleviated if there is an unknown reservoir of nitrogen in comets. The nucleus of comet 67P/Churyumov-Gerasimenko exhibits an unidentified broad spectral reflectance feature around 3.2 micrometers, which is ubiquitous across its surface. On the basis of laboratory experiments, we attribute this absorption band to ammonium salts mixed with dust on the surface. The depth of the band indicates that semivolatile ammonium salts are a substantial reservoir of nitrogen in the comet, potentially dominating over refractory organic matter and more volatile species. Similar absorption features appear in the spectra of some asteroids, implying a compositional link between asteroids, comets, and the parent interstellar cloud., Comment: Main manuscript and Supplementary material document, Accepted for publication in Science on February 14, 2020

Spectroscopic observation is one of the main tools employed to explore the geological features of extraterrestrial environments. In particular, space missions equipped with high resolution imaging spectrometers provide hyperspectral images of planetary surfaces under variable illumination and observation geometries, which represent an essential approach for the understanding of the geochemical context. For instance, combined in situ measurements, remote-sensing observations and laboratory investigations have provided extensive evidence for the presence of water-lain sedimentary rocks on Mars. Coupled with morphological evidence for ancient lakes and valleys, these findings open up questions on the climatic history of Mars, and stimulate the efforts addressed at deciphering whether Mars could have experienced warmer, wetter, and more habitable conditions in its past and consequently if some biological processes could have developed on it. Since the advent of present and future in situ missions to Mars to investigate its properties and to search for traces of life, the analysis of the acquired data requires comparative laboratory measurements. In particular, soil reflection of the sunlight can be interpreted by studying the spectra of artificial and natural terrestrial analogues. Here we present the preliminary results obtained with the Spectro-Gonio Radiometer (working in the 0.3-4.5 μm spectral range) at the Institut de Planétologie et Astrophysique de Grenoble, a facility which mimics the remote and in situ spectroscopic techniques used for the observation of the Martian surface and simulate the conditions of the planet itself (temperature, pressure and composition of the atmosphere). The analysed samples are analogues of Martian brines formed in a sulfur reach environment collected in the Danakil Depression, a particularly extreme environment of the Afar triangle at the junction of the Arabian, Nubian and Somalian lithospheric plates.

Acute respiratory distress syndrome (ARDS) is a rapidly progressive hypoxemic respiratory insufficiency induced by alveolar filling mainly caused by alveolocapillary wall disruption, following direct or indirect pulmonary injury. Much less frequent in children than in adults, pediatric intensivists had long applied adult guidelines to their daily practice. In 2015, experts from the Pediatric Acute Lung Injury Consensus Conference (PALICC) published the first international guidelines specifically dedicated to pediatric ARDS. After a short summary of the history of the ARDS definition since its first report in 1967, we describe the main diagnostic and therapeutic guidelines for PALICC.

Resume Cet article presente les cinq etudes randomisees et controlees, parues dans Medline en 2015, qui ont ete selectionnees par la commission scientifique de la Societe francaise de neonatologie pour leur importance dans le domaine de la perinatologie. Cette selection a ete presentee lors du « Top five » des Journees francophones de recherche en neonatalogie en decembre 2015.

International audience; The French Society of Anesthesia and Intensive Care Medicine and the French Society of Intensive Care edited guidelines focused on hospital-acquired pneumonia (HAP) in intensive care unit (ICU). The goal of 16 French-speaking experts was to produce a framework enabling an easier decision-making process for intensivists. The guidelines were related to 3 specific areas related to HAP (prevention, diagnosis and treatment) in 4 identified patient populations (COPD, neutropenia, postoperative and pediatric). The literature analysis and the formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research over the last 10 years was conducted based on publications indexed in PubMed™ and Cochrane™ databases. HAP should be prevented by a standardized multimodal approach and the use of selective digestive decontamination in units where multidrug-resistant bacteria prevalence was below 20%. Diagnosis relies on clinical assessment and microbiological findings. Monotherapy, in the absence of risk factors for multidrug-resistant bacteria, non-fermenting Gram negative bacilli and/or increased mortality (septic shock, organ failure), is strongly recommended. After microbiological documentation, it is recommended to reduce the spectrum and to prefer monotherapy for the antibiotic therapy of HAP, including for non-fermenting Gram-negative bacilli.

Insoluble Organic Matter (IOM) found in primitive meteorites was formed in the Early Solar System and subsequently processed on the parent asteroids. The location, temporal sequence and processes of formation of this IOM are still a matter of debate. In particular, there is no consensus on the actual effect of post-accretional aqueous alteration processes on the chemical composition and structure of IOM. In the most primitive chondrites (types 1 and 2), these alterations have so far been either neglected or generically assigned to oxidation processes induced by fluid circulation. A series of IOM samples extracted from 14 chondrites with extensively documented post-accretional histories have been studied by infrared spectroscopy. Aqueous alteration shows no detectable effect on the chemical composition and structure of IOM within or across chondrite classes. Indeed, the most effective post-accretional process appears to be a high-temperature short-duration heating event and concerns essentially type 2 chondrites. In any case, post-accretional processes cannot account for all the chemical and structural variations of IOM. Chondrites from the CI, CR and CM classes accreted IOM precursors with moderately variable compositions, suggesting a chemical heterogeneity of the protosolar disk. The 3.4 μm band, and possibly its overtones and combinations in the near-infrared range, appear to be tracer(s) of the chemical class and possibly of surface heating processes triggered by impacts.

MAORY is one of the four instruments for the E-ELT approved for construction. It is an adaptive optics module offering two compensation modes: multi-conjugate and single-conjugate adaptive optics. The project has recently entered its phase B. A system-level overview of the current status of the project is given in this paper.

We report measurements of the equilibrium pressure of single guest clathrate hydrates of C2H6, C2H2, and Kr at low temperatures (mainly in the range (150 to 230) K). The results are compared with other data reported in the literature and used to determine new empirical correlation laws allowing to calculate the equilibrium pressure of clathrates of these species at any temperature below the freezing point of water. Enthalpies of clathrate formation/dissociation for these molecules are estimated using the Clausius–Clapeyron equation and show good agreement with previous reported calorimetric measurements. These results are of particular interest for studies of extraterrestrial ice-rich environments such as comets and icy moons in the solar system.

Le botulisme est une maladie rare chez le jeune enfant, responsable comme chez l’adulte de paralysies flasques par blocage presynaptique de la jonction neuromusculaire. Une intoxination alimentaire apres ingestion d’un produit contenant de la toxine preformee comme de la charcuterie ou des conserves de fabrication artisanale est evoquee chez un patient en âge de consommer ces produits, a fortiori lorsqu’il existe un foyer geographique d’intoxination, mais peut egalement concerner le nourrisson. Le botulisme infantile survenant apres colonisation intestinale par Clostridium botulinum, s’observe exclusivement chez l’enfant de moins d’un an. Le traitement symptomatique necessite dans les situations les plus graves une phase prolongee de soutien ventilatoire et nutritionnel en attendant une recuperation spontanee, souvent ad integrum, mais pendant laquelle les patients sont exposes aux complications de la reanimation. L’administration precoce de serum antitoxinique permet d’accelerer cette recuperation, ce qui suppose que le diagnostic soit evoque rapidement a un âge a priori inhabituel. Nous presentons trois observations recentes illustrant cette maladie, et proposons un protocole pratique facilitant pour le reanimateur les demarches diagnostiques et therapeutiques.

Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome are serious maternal illnesses occurring in the third trimester of pregnancy with significant perinatal and maternal mortality. AFLP may result from mitochondrial defects in the beta-oxidation of fatty acids, in particular a deficiency of the long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) in the fetus. Clinical findings in AFLP vary and its diagnosis is complicated by a significant overlap in clinical and biochemical features with HELLP syndrome. We report the case of 2 siblings who died, the first one in the neonatal period of asphyxia with multivisceral presentation and the second one from sudden death at 7 months. Autopsy of the latter infant revealed hepatic steatosis associated with cardiomyopathy, which led to suspicion of a fatty acid oxidation deficiency. Mutation analysis demonstrated that both children were homozygous for the common mutation c.1528G>C and the parents were heterozygous for this same mutation. This case demonstrates the importance of screening mothers with acute fatty liver disease of pregnancy and their children at birth for a metabolic disease. This article proposes several metabolic tests for mother and child suspected of having beta-oxidation of a fatty acid disorder.

Le choc cardiogenique est une insuffisance circulatoire aigue en lien avec une diminution du debit cardiaque (DC) et une congestion pulmonaire (oedeme). Cet etat correspond a une inadequation entre l’apport et la demande tissulaire en oxygene (O2) de l’organisme. La definition du choc cardiogenique repond a des criteres tres stricts chez l’adulte et repose notamment sur des mesures hemodynamiques invasives. Il peut survenir dans un contexte de cardiopathie preexistante ou non, faire suite ou etre associe a un choc septique, ou survenir sur un terrain d’insuffisance cardiaque prolongee. Chez l’enfant, la definition du choc cardiogenique est davantage clinique en lien avec une incompetence myocardique. Comme chez l’adulte, la realisation d’une echocardiographie est une etape essentielle du diagnostic. Ainsi, malgre les differences de definition, le choc cardiogenique constitue, aussi en pediatrie, le stade ultime de la defaillance cardiaque. L’approche therapeutique devra permettre de corriger une cause curable et de mettre en place des actions precoces et preventives evitant la decompensation notamment chez des enfants connus comme insuffisants cardiaques. Les objectifs principaux du traitement du choc cardiogenique sont de permettre de retablir une contractilite myocardique normale avec une volemie efficace.

This work reports new measurements of the three-phase (ice + clathrate hydrate + vapor) equilibrium in the systems of water and each of the following guest species: xenon from (167.20 to 246.16) K, carbon dioxide from (172.28 to 182.15) K, and methane from (145.75 to 195.74) K. The results are compared with the corresponding data reported in the literature and are used to determine empirical laws allowing the equilibrium pressure of these pure clathrates to be calculated at any temperature relevant to the astrophysical environments below the freezing point of water. These relations can be used in astrophysical models such as those devoted to the studies of the cooling and condensation of the solar nebula or to the ones of the physical evolution and gas production from cometary nuclei.

Resume L’evaluation hemodynamique des patients est une activite quotidienne en reanimation pediatrique. Elle complete et est guidee par l’examen clinique. La volonte de developper une prise en charge la moins invasive possible des patients est un souci constant. La surveillance hemodynamique, a fortiori si elle est invasive, doit sans cesse mettre en balance le benefice et le risque d’entreprendre cette technique chez un patient fragile. Dans les trois dernieres decades, de nombreuses techniques non invasives d’evaluation hemodynamique ont ete developpees. L’outil ideal doit etre fiable, reproductible, avec un temps de reponse rapide, facilement utilisable, avec une totale innocuite, peu couteux et permettant une surveillance continue. Parmi toutes les methodes existantes (doppler œsophagien, echocardiographie transthoracique, NICO®, impedancemetrie thoracique, plethysmographie, capnographie sublinguale), pas une n’allie toutes ces qualites. On peut retenir que l’echographie cardiaque transthoracique se rapproche le plus de ces objectifs. On lui reprochera son cout et le caractere discontinu de la surveillance mais tant dans le diagnostic que dans la surveillance, elle n’a pas d’egal parmi les outils non invasifs d’evaluation hemodynamique de part la qualite et la quantite des informations obtenues. L’apprentissage des fonctions permettant l’evaluation de la contractilite et du remplissage cardiaque, du remplissage vasculaire et de la reponse aux traitements entrepris est relativement aisee. On regrettera l’absence de formation a l’echocardiographie transthoracique en France dans sa specificite pediatrique et neonatale dans le cadre d’un diplome universitaire ou interuniversitaire.

The optimal age for measles vaccination is an important health issue, since maternal antibodies may neutralize the vaccine antigen before a specific immune response develops, while delaying vaccination may increase the risk of complicated diseases in infants. However, measles vaccination impacts the duration of protection afforded by transplacental transfer of maternal antibodies: vaccination-induced maternal antibodies disappear faster than disease-induced antibodies. In order to maintain protection against measles in infants, it is important to monitor the dynamics of this phenomenon in vaccinated populations. To assess the current situation in France, a multicenter, prospective seroepidemiological study was conducted in seven French hospitals between October 2005 and January 2007. Maternal measles antibody concentrations from 348 infants 0 to 15 months old were measured using the plaque reduction neutralization assay. Geometric mean concentrations and the percentage of infants with maternal measles antibody concentrations above the protection threshold (≥120 mIU/ml) were assessed according to age. Results show that after more than 20 years of routine measles vaccination in France, maternal measles-neutralizing antibodies decrease dramatically in French infants by 6 months of age, from 1,740 mIU/ml for infants 0 to 1 month old to 223 mIU/ml for infants 5 to 6 months old, and that 90% of infants are not protected against measles after 6 months of age. Infant protection against measles could be optimized both by increasing herd immunity through an increased vaccine coverage and by lowering the age of routine vaccination from 12 to 9 months.

Resume La couverture vaccinale (CV) contre la rougeole a augmente de facon significative en France des 1983 (annee de la recommandation officielle). La majorite des femmes nees apres 1983 serait donc davantage immunisee par la vaccination plutot que par la maladie. Les anticorps antirougeole (AcR) maternels transmis pendant la grossesse protegent les nourrissons pendant les premiers mois de vie. Objectif Comparer les titres d’AcR neutralisants en fonction de l’âge chez les femmes de 12 a 40 ans, nees avant et apres 1983. Methodes Etude seroepidemiologique multicentrique realisee en France (octobre 2005–mai 2006). Au total, 210 femmes hospitalisees ou consultant a l’hopital ont ete inclues et reparties en 4 groupes d’âge (12–18 ; 19–22 ; 23–30 et 31–40 ans). Mesure des titres d’AcR par le test de reference de neutralisation par reduction de plages (seuil de protection > 120 mUI/ml). Resultats La moyenne geometrique des titres (MGT) d’AcR etait significativement superieure chez les femmes nees avant 1983 versus apres 1983 (MGT : 1358 versus 731 mUI/ml [ p p re fois en France, nous montrons que chez les femmes en âge de procreer les titres moyens des AcR neutralisants sont en 2005–2006 largement au-dessus du seuil de protection, quel que soit l’âge et que les femmes les plus jeunes (CV elevee) ont des titres significativement plus bas. La duree de protection conferee par les AcR transmis a leurs nourrissons pourrait ainsi etre reduite.

Resume Malgre les progres de la medecine perinatale, les consequences d’une encephalopathie hypoxique-ischemique chez le nouveau-ne a terme peuvent gravement compromettre le devenir neurologique du patient. La prise en charge initiale de ces patients impose un diagnostic lesionnel et un traitement precoces. L’evaluation pronostique reste difficile, reposant sur l’association d’un faisceau d’arguments. De nombreux travaux ont montre l’interet pronostique de l’imagerie par resonance magnetique (IRM) dans l’evaluation de l’encephalopathie hypoxique-ischemique. Plus recemment, la spectroscopie par resonance magnetique (SRM) a, elle aussi, montre un interet dans cette situation. Objectif Evaluer la place de ces examens dans un tel contexte. Materiel et methodes Nous avons etudie une serie de 26 patients ayant presente une souffrance neurologique a terme. Nous avons compare les resultats obtenus en IRM et en SRM a leur evolution clinique. En IRM, nous avons propose un score chiffre utilisant des criteres valides en imagerie conventionnelle et en diffusion. Resultats Ce score a montre un lien significatif avec l’evolution. Nos resultats ont confirme l’interet pronostique de la spectroscopie. Les rapports faisant intervenir le lactate (Lac/NAA, Lac/Cho et Lac/Cr) avaient un lien significatif avec l’evolution clinique. La specificite de l’augmentation de ces rapports etait bonne, la sensibilite n’est pas parfaite. Une valeur au dela de 0,3 pour le rapport Lac/NAA a paru representer un element de mauvais pronostic. Conclusion La realisation d’un examen par resonance magnetique associant sequences conventionnelles, imagerie de diffusion et spectroscopie localisee et realise au mieux apres un delai de trois a quatre jours de vie nous parait un element indispensable de la strategie diagnostique et pronostique devant une encephalopathie hypoxique-ischemique.

Resume Les intoxications aigues chez l'enfant necessitant une prise en charge en unite de reanimation pediatrique (URP) restent rares. Le caractere « dynamique » de l'intoxication, avec la possibilite d'une symptomatologie differee ou retardee explique l'importance d'une surveillance (generalement

Resume La grande prematurite fait l'objet en France depuis 1997 d'une etude de suivi specifique : Epipage. Le taux de rehospitalisation des grands prematures de la cohorte Epipage, pendant la premiere annee de vie, etait de 38 %. Objectif de l'etude. – Depuis la mise en place d'une procedure systematique de sortie des enfants grands prematures en 1997, nous avons souhaite comparer le taux de rehospitalisation dans l'annee qui suit leur naissance, au sein de 2 cohortes de grands prematures nes respectivement en 1997 et 2002. Objectif secondaire : comparer le taux de rehospitalisation observe en 1997 aux donnees de la litterature (dont la cohorte Epipage). Populations et methodes. – Tous les enfants d'âge gestationnel (AG) inferieur ou egal a 32 semaines d'amenorrhee (SA), nes en 1997 et 2002, domicilies en Gironde, sortis des services de neonatologie de l'hopital des Enfants de Bordeaux, et rehospitalises ou non dans les 365 jours suivant leur naissance ont ete inclus. Les donnees ont ete recueillies de maniere retrospective. Resultats. – 29,1 % des enfants nes en 1997 et 30,1 % de ceux nes en 2002 ont ete rehospitalises au moins une fois au cours de leur premiere annee de vie. Le nombre moyen d'hospitalisations par enfant (1,66 en 1997 et 1,77 en 2002) et la duree cumulee des hospitalisations (11,8 jours en 1997 et 16,8 jours en 2002) etaient comparables. Une affection respiratoire a ete le principal motif de readmission pour les 2 cohortes. Plusieurs facteurs sont correles a un risque accru de rehospitalisation : le poids de naissance inferieur 1000 g, l'existence d'une dysplasie bronchopulmonaire (DBP) et un AG Conclusion. – Le taux de rehospitalisation est reste inchange entre 1997 et 2002 alors que la gravite de l'etat de sante de ces enfants (hypotrophie, tres grande prematurite, DBP) augmentait. La mise en place de procedures specifiques de sortie et de suivi pour ces enfants est une evolution benefique dans leur prise en charge. Nous pensons necessaire de poursuivre cette prise en charge au-dela de la sortie par l'etablissement d'un reseau tripartite fort reunissant les acteurs de sante de ville, ceux de l'hopital et les parents.

Resume But de l'etude. – Evaluer les pratiques de pose des catheters centraux dans les unites de neonatologie et la survenue d'epanchements pericardiques (EP) au cours des cinq dernieres annees. Materiel et methode. – Enquete par questionnaire sur la periode 1999–2004 aupres de 38 centres (16 niveaux II, 22 niveaux III). Etude retrospective des cas d'EP dans cinq centres. Resultats. – Trente-quatre centres (89 %) ont repondu. Les positions acceptees des extremites des catheters etaient la jonction oreillette droite–veine cave (OD–VC) pour 76 % des centres, la VC pour 58 %, et dans l'OD pour 11 %. Cinquante pour cent des centres ont ete exposes aux EP. Seize dossiers d'EP provenant de cinq centres ont ete etudies : âge median de 31 semaines d'amenorrhee (SA) (extremes : 26,1–40 SA), delai median entre la pose du catheter et la survenue de l'EP de 3,2 jours (0,4–13,5) ; catheters impliques : sept catheters veineux ombilicaux, huit percutanes, deux sous-claviers. Dans tous les cas, l'extremite du catheter etait en position intracardiaque a la pose avec retraits insuffisants dans 13 cas. Cliniquement, l'EP a ete revele par un arret cardiaque (huit cas), une instabilite cardiorespiratoire (six) ou etait asymptomatique (deux) avec augmentation de l'index cardiothoracique (11/16) et catheter intracardiaque (15/16). Le diagnostic a ete fait par l'echographie dans 14 cas, en post-mortem dans un cas. La prise en charge a associe ponction pericardique (13 cas) et retrait du catheter (12 cas). L'evolution s'est faite vers le deces dans quatre cas, et deux enfants ont garde des sequelles neurologiques. Conclusion. – La survenue d'EP est associee a la position intracardiaque du catheter. Sa position doit etre verifiee systematiquement par radiographie ou echographie. Toute symptomatologie cardiorespiratoire inexpliquee chez un nouveau-ne porteur d'un catheter central doit faire evoquer un EP.

X-ray diffraction experiments were carried out on large ice crystals from accreted ice above Lake Vostok, a subglacial lake lying beneath the East Antarctic ice sheet. Results indicate a surprisingly very low lattice distortion. This crystalline quality does not seem to be affected by impurities. Abnormal grain growth should occur and could explain both the large grain size and the low lattice distortion. Accreted ice is therefore supposed to be non-plastically deforming. These results should be taken into account for further studies of the permeability of accreted ice to drilling fluid present in the borehole.

Multiple sclerosis (MS) is rare in children and occurs exceptionally before ten years. Sex ratio (girl/boy) is around 2.5 to 3, higher than in adults. Brain stem dysfunction and meningeal symptoms are more commonly first manifestations of the disease than in adults. Optic neuritis is also a frequent early manifestation. The etiology of the disease remains unclear and none of the advanced hypotheses (infectious, genetic, environmental) can by themselves explain its occurrence. There is a genetic susceptibility which is probably linked to many genes leading to a low related risk (less than two). A viral trigger mechanism in a person with a genetic predisposition is possible. New therapies result from a better understanding of the closed immune mechanisms of the disease.

An optimized spectrophoto‐goniometer was designed to study the Bidirectional Reflectance and Polarization Distribution Functions (BRDF and BPDF) of several types of materials such as minerals, salts and molecular solids (called “ices”) existing on the surfaces of solar system icy satellites. It covers the solar spectrum (λ e [0.3, 5 μm]) and a wide range of geometric configurations. Using this device we hope to achieve an improved understanding of BRDF and BPDF behaviors of granular surfaces and a validation of current radiative transfer models. Description of both spectral and photometrical calibration protocols and initial results on water ice and sulfur powder are presented.

Resume Les gangliogliomes constituent une entite nosologique controversee. Ils sont classes parmi les tumeurs neuronales et neuronogliales. Patients et methodes Les auteurs rapportent six observations de gangliogliomes. L'âge au moment du diagnostic etait de 4 mois a 15 ans (âge moyen: 4 ans et 6 mois). Ils ont tous presente initialement une epilepsie partielle active, pharmacoresistante. Les six enfants ont ete operes, l'un a deux reprises. Le diagnostic a ete porte a partir de l'etude immunohistochimique de la piece d'exerese. Commentaires Ces tumeurs benignes, de bon pronostic malgre une epilepsie le plus souvent severe et revelatrice, sont de diagnostic difficile sur le plan radiologique (astrocytomes et dysplasies corticales) et histologique. Conclusion La certitude immunohistochimique permet d'adopter une attitude therapeutique coherente. Quand l'exerese est complete, la chirurgie s'accompagne d'un excellent pronostic.

Combined factors V (FV) and VIII (FVIII) deficiency is a rarely seen hereditary coagulation disease. Experience of its management in surgery with a high-risk of bleeding is rare. The interest of this case report is to propose a strategy of perioperative management for such a deficit, but also to recall that a careful preoperative anesthetic evaluation with questioning and physical examination permits to detect unsuspected coagulation disorders and to schedule the preventive treatment. The protocol for the perioperative period consisted of the administration of desmopressin and fresh frozen plasma one hour before surgery. The administration of desmopressin was continued for 48 hours. Fresh frozen plasma and tranexamic acid were administered during the first 9 postoperative days. A local bleeding occurred at 8 days (scab coming off) and required systematically a surgical hemostasis and an intensification of the therapeutic protocol. Recombinant plasmatic factor VIII was administered for 7 days together with a daily perfusion of fresh frozen plasma for a total treatment period of 14 days.

International audience; Carbonates are abundant sedimentary minerals at the surface and sub-surface of the Earth and they have been proposed as tracers of liquid water in extraterrestrial environments. Their formation mechanism is since generally associated with aqueous alteration processes. Recently, carbonate minerals have been discovered on Mars' surface by different orbital or rover missions. In particular, the phoenix mission has measured from 1 to 5% of calcium carbonate (calcite type) within the soil (Smith P.H. et al., 2009). These occurrences have been reported in area were the relative humidity is significantly high (Boynton et al., 2009). The small concentration of carbonates suggests an alternative process on mineral grain surfaces (as suggested by Shaheen et al., 2010) than carbonation in aqueous conditions. Such an observation could rather point toward a possible formation mechanism by dust-gas reaction under current Martian conditions. To understand the mechanism of carbonate formation under conditions relevant to current Martian atmosphere and surface, we designed an experimental setup consisting of an infrared microscope coupled to a cryogenic reaction cell (IR-CryoCell setup). Three different mineral precursors of carbonates (Ca and Mg hydroxides, and a hydrated Ca silicate formed from Ca2SiO4), low temperature (from -10 to +30°C), and reduced CO2 pressure (from 100 to 2000 mbar) were utilized to investigate the mechanism of gas-solid carbonation at mineral surfaces. These mineral materials are crucial precursors to form Ca and Mg carbonates in humid environments (0 < relative humidity < 100%) at dust-CO2 or dust-water ice-CO2 interfaces. Our results reveal a significant and fast carbonation process for Ca hydroxide and hydrated Ca silicate. Conversely, only a moderate carbonation is observed for the Mg hydroxide. These results suggest that gas-solid carbonation process or carbonate formation at the dust-water ice-CO2 interfaces could be a currently active Mars' surface process. To the best of our knowledge, we report for the first time that calcium carbonate can be formed at a negative temperature (-10°C) via gas-solid carbonation of Ca hydroxide. We note that the carbonation process at low temperature (

L’activite quotidienne en unite de reanimation pediatrique (URP) est indissociable de l’evaluation hemodynamique des patients. Les maladies et leurs traitements impliquent une appreciation tres precise du statut hemodynamique des enfants hospitalises. Les informations recueillies par le simple examen clinique (frequence cardiaque FC, pression arterielle PA, coloration cutanee, etc.) constituent le socle de toutes les evaluations ulterieures. Il faut considerer que les resultats des evaluations hemodynamiques realisees ne sont qu’une contribution dans la prise en charge du patient et qu’il est necessaire de les inclure dans une evaluation plus globale, clinique et paraclinique. La volonte de developper une prise en charge la moins invasive possible des patients en URP est un souci constant. La surveillance hemodynamique, a fortiori si elle est invasive, doit sans cesse mettre en balance le benefice et le risque d’entreprendre cette technique chez un patient fragile. Les patients en URP ne requierent pas tous une evaluation hemodynamique invasive.

Le choc cardiogenique est une insuffisance circulatoire aigue due a une alteration de la contractilite myocardique a l’origine d’une diminution du debit cardiaque (DC) et une congestion pulmonaire (œdeme) [1]. Comme tout etat de choc, c’est une situation d’inadequation entre l’apport et la demande tissulaire en oxygene (O2) et en nutriments de l’organisme mais, dans ce cadre nosologique, directement liee a une incompetence myocardique.

Chylothorax is defined as an accumulation of chyle in the pleural space. This condition usually occurs after an operation, the congenital idiopathic form being rare (1/15thin000 births). Recovery is observed within four to six weeks of diagnosis in most cases. Treatment is either conservative or surgical. Four cases are reported of congenital chylothorax (three idiopathic, one accompanied by diffuse lymphangectasia) managed by chemical pleurodesis (intrapleural injection of povidone-iodine). Tolerance was satisfactory: unaltered thyroid function in the three cases explored; one case of transient generalised oedema. Treatment was deemed successful in three of the four cases. One child died from renal failure (unrelated to the chemical pleurodesis). Pleurodesis by povidone-iodine appears to be well tolerated and may represent a good alternative to mechanical abrasion or surgery for congenital idiopathic chylothorax. Its use for refractory chylothorax may also decrease the morbidity related to prolonged hospital stay.

Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome are serious maternal illnesses occurring in the third trimester of pregnancy with significant perinatal and maternal mortality. AFLP may result from mitochondrial defects in the beta-oxidation of fatty acids, in particular a deficiency of the long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) in the fetus. Clinical findings in AFLP vary and its diagnosis is complicated by a significant overlap in clinical and biochemical features with HELLP syndrome. We report the case of 2 siblings who died, the first one in the neonatal period of asphyxia with multivisceral presentation and the second one from sudden death at 7 months. Autopsy of the latter infant revealed hepatic steatosis associated with cardiomyopathy, which led to suspicion of a fatty acid oxidation deficiency. Mutation analysis demonstrated that both children were homozygous for the common mutation c.1528GC and the parents were heterozygous for this same mutation. This case demonstrates the importance of screening mothers with acute fatty liver disease of pregnancy and their children at birth for a metabolic disease. This article proposes several metabolic tests for mother and child suspected of having beta-oxidation of a fatty acid disorder.

In the USA, the incidence of invasive candidiasis in neonates is respectively 0.3% of infants over 2500 g and up to 20% of infants less than 1000 g. Their incidence is increasing. Two populations of newborn infants are particularly vulnerable: the premature infants and newborn infants with severe neonatal digestive diseases. Fifty percent of infants hospitalized in NICU are colonized with Candida at the end of the first week of hospitalization; a direct relationship exists between the importance of colonization and the invasive infection risk. C. albicans is the species most often responsible for invasive candidiasis in the newborn. These infections represent the third cause of related-catheter infection in the USA. Mortality rate in neonates linked to this disease is 20 to 50%; morbidity primarily concerns brain and lungs. Neonatal invasive candidiasis risk factors are known and a primary prevention is possible. The diagnosis of neonatal invasive candidiasis is difficult and often delayed because of a polymorphic clinical expression. Empiric and preemptive treatment are based on the use of amphotericin B. Prophylactic treatment using fluconazole of newborns with birth weight ≤ 1000 grams and/or gestational age ≤ 27 weeks gestation is recommended by the American Academy of Paediatrics and the Infectious Diseases Society of America. A better knowledge of French epidemiological data in this area would improve both the diagnosis and therapeutic management of this disease.