[The contribution of the clinical examination, electroencephalogram, and brain MRI in assessing the prognosis in term newborns with neonatal encephalopathy. A cohort of 30 newborns before the introduction of treatment with hypothermia]. / Évaluation du pronostic de l'encéphalopathie précoce du nouveau-né à terme avant l'avènement de l'hypothermie.

OBJECTIVES: Perinatal asphyxia complicated by hypoxic ischemic brain injury remains a source of neurological lesions. A major aim of neonatologists is to evaluate the severity of neonatal encephalopathy (NE) and to evaluate prognosis. The purpose of this study was to determine the contribution of brain MRI compared to electroencephalogram (EEG) and clinical data in assessing patients' prognosis. MATERIALS AND METHODS: Thirty newborns from the pediatric resuscitation unit at Rouen university hospital were enrolled in a retrospective study between January 2006 and December 2008, prior to introduction of hypothermia treatment. All 30 newborns had at least two anamnestic criteria of perinatal asphyxia, one brain MRI in the first 5 days of life and another after 7 days of life as well as an early EEG in the first 2 days of life. Then, the infants were seen in consultation to assess neurodevelopment. RESULTS: This study showed a relation between NE stage and prognosis. During stage 1, prognosis was good, whereas stage 3 was associated with poor neurodevelopment outcome. Normal clinical examination before the 8th day of life was a good prognostic factor in this study. There was a relationship between severity of EEG after the 5th day of life and poor outcome. During stage 2, EEG patterns varied in severity, and brain MRI provided a better prognosis. Lesions of the basal ganglia and a decreased or absent signal of the posterior limb of the internal capsule were poor prognostic factors during brain MRI. These lesions were underestimated during standard MRI in the first days of life but were visible with diffusion sequences. Cognitive impairment affected 40% of surviving children, justifying extended pediatric follow-up. CONCLUSION: This study confirms the usefulness of brain MRI as a diagnostic tool in hypoxic ischemic encephalopathy in association with clinical data and EEG tracings.

[Early spontaneous ileal perforations in preterm infants: report of 4 cases]. / Perforations iléales précoces sans signes d'entérocolite ulcéronécrosante: à propos de quatre cas survenus chez des prématurés.

An ileal perforation occurred shortly after birth in 4 very premature newborns. Diagnosis was made on an abdominal distension with a pneumoperitoneum on X-ray. There were no biological, radiological nor histological signs of necrotizing enterocolitis. There were no digestive short- or long-term complications. According to the few authors who described this syndrome, there are some risk factors, but they were not clearly involved in our cases. Ileal perforation in the absence of signs of necrotizing enterocolitis is rarely reported but should be well known because of its good prognosis.

[Recurrence of herpes simplex encephalitis]. / Rechute d'encéphalite herpétique.

UNLABELLED: Herpes simplex encephalitis (HSE) rarely occurs in children, is not easily diagnosed, and has a poor prognosis. CASE REPORT: We report a pediatric case with a relapse on the 29th day despite conventional acyclovir therapy. As the relapse mechanism is not clearly understood, antiviral and immunosuppressive therapy was administered. CONCLUSION: This case underlines the importance of clinical examination and the necessity of accurate testing prior stopping antiviral treatment. A better understanding of the relapse mechanism is required in order to propose more efficient treatment.

[Esophageal bezoar in a child treated with sucralfate]. / Bézoard oesophagien chez un enfant traité par sucralfate.

BACKGROUND: Sucralfate is widely used in stress bleeding prophylaxis in intensive care units as it causes relatively few side effects. Its use in patients with risk factors may lead to the formation of esophageal bezoar. We describe the first known pediatric case of sucralfate esophageal bezoar. CASE REPORT: A 11-year-old girl presented with severe encephalitis complicated by seizures. She was treated in an intensive care unit by restrictive hydration associated with sucralfate, morphinic compound, phenobarbital and curare. At day 10, enteral feeding through a nasogastric tube was started. Five days later, an esophageal bezoar was diagnosed, which disappeared after discontinuing sucralfate, morphinic compound, curare and enteral feeding. CONCLUSIONS: Risk factors, similar to those reported in adults with esophageal bezoars, were found in this patient ie, plurimedication, dehydration, impaired gastric motility. Caution should be taken when combining enteral feeding and sucralfate whenever any additional risk factor is present.

Prognostic value of neonatal electroencephalography in premature newborns less than 33 weeks of gestational age.

In a prospective study of 417 premature neonates born before 33 weeks' gestational age, neonatal tracings were reviewed to evaluate the use of EEG in prognosis of neurological injuries. The population was divided into two groups: Group 1, infants who died before the age of 1, and Group 2, survivors in which two categories of motor development were considered. Category A, were abnormal, and Category B, were always normal. Positive rolandic sharp waves (PRSW), which reflect white matter injury, occurred equally in both groups, indicating a similar incidence of white matter damage in Groups 1 and 2. In Group 2, there was a significant correlation of PRSW with developmental motor sequelae (Category A). A frequency of PRSW above 2/min (suggesting more severe periventricular white matter injury) and seizures were significantly more prevalent in Group 1 than in Group 2 and in Category A of Group 2 than in Category B. Background abnormalities occurred equally in both subgroups of extremely premature infants (< or = 28 weeks' gestation) they were significantly more numerous in the subgroup of very premature infants (between 28 and 33 weeks' gestation) who died, than in the subgroup of very premature infants who survived. This study shows the potential utility of using neonatal EEG in association with transfontanellar ultrasonography in anticipating the neurological development of very (> 28 weeks' gestation) and extremely (< or = 28 weeks' gestation) premature newborns.

[Neonatal septicemia due to Pneumococcus resistant to beta-lactam antibiotics]. / Septicémie néonatale à pneumocoque résistant aux bêtalactamines.

BACKGROUND: Neonatal sepsis due to Streptococcus pneumoniae is relatively rare. The increasing risk that this bacterium is resistant to betalactam antibiotics worsens its prognosis. CASE REPORT: A newborn was delivered by cesarean section because of an abnormal fetal heart rate pattern. Despite intubation, respiratory support and correction of acidosis, the baby remained cyanotic and displayed signs of shock. Neutropenia, increased percentage of immature neutrophils, high C-reactive protein levels and an X-ray pattern of pneumonia also indicated an infection. The child was given symptomatic therapy, and amoxicillin, cefotaxime and amikacin. Pneumococci type 9 were isolated from peripheral secretions and from the blood. Deterioration of the respiratory condition required higher doses of amoxicillin and cefotaxime on day 2 pending the results of antibiotic sensitivity testing. This test showed that the strains were resistant to beta-lactam antibiotics. On day 3, the treatment was replaced by a combination of vancomycin, rifampicin, amikacin and cefotaxime. This treatment was pursued for 2 weeks, except for rifampicin which was stopped after 2 days. The follow-up was uneventful. A search for pneumococci in the mother was negative. CONCLUSIONS: Streptococcus pneumoniae should always be considered as a cause of neonatal sepsis. Poor therapeutic control indicates resistance to beta-lactam antibiotics. This patient may be the first reported case of maternal-fetal infection with this resistant strain.

[Systemic gas embolism in the greater circulation in a ventilated premature infant]. / Embolie gazeuse massive de la grande circulation chez un prématuré ventilé.

BACKGROUND: Pneumothorax is common complication in newborns; its incidence is increased by intubation, particularly when high pressure ventilation is necessary. Systemic air embolism is a rare and usually fatal form of "displaced air". CASE REPORT: A preterm newborn, 27 weeks of gestational age, weighing 940 g, with respiratory distress syndrome was treated by intubation at 1 min of life and high pressure ventilation (Peak 36 cmH2O, PEP 6 cmH2O, FiO2 = 1). Bilateral pulmonary interstitial emphysema was seen on X-rays at 4 hr of life. Acute cyanosis and bradycardia occurred at 7 hr of life; large amounts of air mixed with blood were withdrawn from the umbilical vein catheter. There was no pneumothorax, pneumomediastinum or subcutaneous emphysema. The newborn died at 9 hr of life. Post mortem injection of contrast fluid into umbilical vein catheter indicated no cardiac perforation: this finding was confirmed by autopsy. CONCLUSION: This is a new case of systemic air embolism that may be due to high pressure ventilation in an extremely underweight newborn. Preventive measures consist of monitoring ventilation, possibly using new techniques, but their efficacy remain to be demonstrated.

[Contribution of the EEG and evoked potentials in the prognosis of post-anoxic comas in children]. / Apport de l'EEG et des potentiels évoqués dans le pronostic des comas postanoxiques de l'enfant.

Six children with post-anoxic coma were studied and there was evidence of preserved brainstem function together with the presence of electrocerebral activity on EEG. There is no definite prognosis with slow EEG; patients can either die, survive, but with major neurological damage, or recover completely. In that case, evoked potentials have a good prognostic value. Normal BAEP indicate that patients will survive. However, absence of the cortical component of SEP indicates major cerebral damage. Evolution towards a vegetative state can therefore be predicted.

[Continuous flow rate respirators. Proposals for changes in the circuits]. / Ventilateurs à débit continu. Propositions de modification des circuits.

It is suggested that the circuits of continuous flow rate ventilators should be modified for more accurate control of ventilation parameters. Reduction in compressible volume and increase in caliber of the expiratory section have resulted in a better control of pressure curve and level of expiratory pressure and in reduction of condensation in the inspiratory circuit.

[Peripheral arterial catheterization in neonates and infants. Remote study of the arterial permeability by the Doppler effect]. / Cathétérisme artériel périphérique chez le nouveau-né et le petit nourrisson. Etude à distance de la perméabilité artérielle par effet Doppler.

Nineteen peripheral arteries were examined by Doppler US 1 month to 2 years after their catheterization. Two of them were completely obstructed and 4 showed signs of arterial stenosis. No functional repercussion was observed. This minor risk seems low as compared to the advantages of the technique.

[Intermediate neurological development of 60 neonates weighing 1500 grams or less at birth. Predictive value of initial findings (clinical aspects, electroencephalograms and brain imaging)]. / Evolution neurologique à moyen terme de 60 nouveau-nés pesant 1,500 grammes ou moins à la naissance. Valeur prédictive des données initiales (clinique, électroencéphalogramme et imagerie encéphalique).

60 low birthweight (less than or equal to 1,500 g) are distributed according to existence or not, and intensity of brain disturbances, during the neonatal period; appreciated by neurological examinations, early EEG and brain imaging during the second month of life. At 18 months, at least, neurological outcome is normal for 46 children (but 6 had transient neuromotor anomalies), 14 have sequelae (7 mild, 7 major). All children with clinical neurological examination carried out during the neonatal period are normal at follow up. It is true also for the children without EEG anomaly and normal brain imaging. The early prediction of neurological outcome can be made easily with consideration of these three data. Standardised test are proposed, during the neonatal period, for these low birth weight infants.

[Interstitial emphysema of the right lung. Treatment with bronchial occlusion in a premature infant]. / Emphysème interstitiel du poumon droit. Traitement par occlusion bronchique chez un prématuré.

Interstitial emphysema of the right lung occurring as a complication of hyaline membrane disease in a premature infant was successfully treated by bronchial occlusion with a balloon catheter. This technique was simpler and safer than selective intubation of the left main bronchus.

[Circulating calcitonin in fulminating purpura in children]. / Calcitonine circulante au cours du purpura fulminans de l'enfant.

Hypocalcaemia may complicate the treatment of fulminating meningococcaemia in children. In an attempt to elucidate the pathophysiology of the hypocalcaemia, we have measured accompanying changes in blood levels of calcitonin (BW-336-6 antiserum) and parathyroid hormone (C-terminal antiserum IRE). Ten children aged 1-11 years with fulminating meningococcaemia are studied. The high PTH levels may be a response to the hypocalcaemia, but the hypercalcitoninaemia seems inappropriate. Provided the immunoreactivity of the calcitonin detected corresponds to calcitonin 1-32, the origin of this hypercalcitoninaemia remains to be explained.

[Acute neurological deficit in treated malignant hemopathies]. / Accidents neurologiques aigus déficitaires au cours d'hémopathies malignes traitées.

Neurological complications are frequent in the course of malignant hematological diseases. Five cases occurring in children are reported here: 4 presented with acute lymphoblastic leukemia and 1 with lymphoma. The clinical pattern was remarkably acute, with fever, seizures and a neurological deficit. Brain CT scan showed a limited hypodensity sometimes with a contrast uptake in the involved area in the first days or weeks. Seroconversion for measles virus occurred in 3 cases, associated with the presence of helix-like bodies in the cerebrospinal fluid and/or cerebral tissue. These case reports are discussed with respect to the neurological complications already reported in patients with hematologic malignancies. The hypothesis of measles-virus related encephalitis seems likely.

[Polyradiculoneuritis as a manifestation of childhood sarcoidosis]. / Polyradiculonévrite révélatrice d'une sarcoïdose de l'enfant.

A case of juvenile sarcoidosis presenting initially as Guillain-Barré syndrome is reported. Biochemical and radiologic data (bilateral hilar lymphadenopathies) led to suspect the diagnosis which was assessed by bronchial biopsy. Evolution was marked by spontaneous neurologic recovery, while the evolution of the pulmonary disease needed corticosteroid treatment. After a 3 year follow-up, chest X-rays are considered normal and the only pathologic findings are minimal changes in functional respiratory investigations.

[Hepatitis B with a fatal outcome in a 3-month-old infant of a healthy chronic carrier mother]. / Hépatite virale à virus B avec issue fatale chez un nourrisson de 3 mois né de mère porteuse saine chronique.

A 81 day old male infant developed an acute hepatitic failure and died shortly thereafter. Determinations of HBs antigen and antibody (AB) and HBeAg and AB were performed in the parents and sibling of the infected child. The mother and a sister were an asymptomatic carrier of HBsAg, the first HBeAg positive and the second HBeAB positive. An elder sibling was HBsAg and HBeAg positive in this serum. The father was anti-HBs positive. In the family of the sister, the man and two childs were HBsAg and anti-HBsAB negative. A new baby in the family of the propositus born and a combination of HB vaccine and HBIg (hepatite B immuno-globulin) was started at birth. Unfortunately the child died of S.D.I.S. (Sudden Death Infant Syndrome). The HB vaccine was immuno-genetic in this infant and the anti-HBs in the immuno-globulin M (IgM) was positive as in several adults controls. This case allow us to discuss vertical transmission of hepatitis B, the clinical aspect of neonatal hepatitis and the preventing HB infection by combinaison of HB vaccine and HBIg.

[Obstruction of the abdominal aorta and cyanotic heart disease in a 1 year old child (author's transl)]. / Oblitération de l'aorte abdominal et cardiopathie cyanogène chez un enfant de 1 an.

In a 1 year old child, cyanotic congenital heart disease was complicated by a severe obstruction of the abdominal aorta between the renal arteries and the bifurcation. The surgical treatment consisted of relief of the obstruction in the aorta and a Blalock-Taussig shunt. The general progress was good but there was a ischemia of the left leg for which amputation of the forefoot was required.