[Does stopping of oral feeding favour the occurrence of auriculoventricular block in premature infants treated with diphemanil?]. / L'arrêt de l'alimentation orale favorise-t-il la survenue d'un bloc auriculoventriculaire chez les prématurés traités par diphémanil?

BACKGROUND: Bradycardia in preterm infants may require anticholinergic therapy (diphemanil methylsulphate). Such treatment may cause prolongation of QT interval and auriculoventricular block. CASE REPORTS: Three premature infants born before 34 weeks of gestational age were given 6-8 mg/kg/d diphemanil because they suffered from bradycardiac episodes. Aggravation and/or persistence of bradycardia required withdrawal of gavage feeding: heart block occurred within a few hours which subsided after cessation of diphemanil and oral refeeding. Diphemanil at progressive dosage was later introduced safely in two of these infants. CONCLUSION: The short interval of time between the oral feeding withdrawal and occurrence of heart block justified therapy be stopped or transiently reduced whenever oral feeding must be interrupted.

[Nutritional fetal rickets. A case report]. / Le rachitisme carentiel du foetus. A propus d'un cas.

We report the case of a newborn who showed typical signs of rickets at birth craniotabes and severe hypocalcemia. The diagnosis of fetal rickets was confirmed by radiography. Maternal deficiency was revealed by an excessively low vitamin D level. The multiparous Moroccan mother had suffered low back pain and paraesthesia for several years. She wore the veil and rarely left her home. Nutritional and vitamin D deficiency was demonstrated. We report this exceptional case to recall the importance of vitamin D in the development of fetal calcium supply, the prevention of gravid osteomalacia and the prevention of neonatal hypocalcemia. Vitamin D supplementation (ideally 1000 IU per day during the third trimester or at least one 100,000 IU dose at the sixth and eighth months or a single dose of 2 to 3,000,000 IU at the sixth month) should be the rule in pregnancy.

[Surveillance of antibiotic therapy in a pediatric intensive care unit]. / Surveillance de l'antibiothérapie en unité pédiatrique des soins intensifs.

Since 1982, a pediatric intensive care unit for neonates and pediatric patients up to 15 years of age has prospectively recorded every instance of use of antimicrobials, with the reasons for use, clinical and bacteriological parameters, and outcome. This approach encourages strict adherence to established protocols and provides a basis for discussing the rationale of each antimicrobial course. Effectiveness of protocols is evaluated annually and modifications or additions are introduced, as appropriate. Patterns in the proportion and nature of antimicrobials used to treat hospital-acquired infections can be monitored on the basis of the data collected. Changes in the nature of antimicrobials used, which may have repercussions on pathogen resistance to antimicrobials, are also monitored. Reasons for use of antimicrobials are categorized as follows: A = primary infection: B = secondary infection acquired in the ICU; C: secondary infection acquired in another unit or in another hospital; D = prophylaxis. In 1987, 46% of neonates and 59% of patients above one month of age were given antimicrobial agents; these figures are similar to those recorded during the previous years. Reasons for antimicrobial therapy were as follows in neonates: A = 48.5%; B = 40%; C = 1.2%; D = 10.3%; in patients above one month of age corresponding figures were: A = 23%; B = 44%; C = 0.9%; D = 31.9%. Among the neonates, the ampicillin-aminoglycoside combinations accounted for 41.5% of treatments (1/4th of these treatments were continued); in the older patients, penicillin G and ampicillin were the most commonly used antibiotics. In all age groups, hospital-acquired infections were mainly respiratory tract infections (approximately 50% in neonates and 80% in patients above one month of age). Staphylococcus aureus was the most prevalent organism; Pseudomonas was seen virtually only among the patients above one month of age with very prolonged endotracheal intubation. From 1983 through 1987, use of third-generation cephalosporins increased from 4.5% to 28.3% in neonates and from 5.5% to 9% for patients above one month of age. The changes identified over time should be interpreted in the light of changing patterns of disease; in particular, hospital-acquired infections among neonates increased twofold, probably as a result of the rising number of very-low-birth-weight infants.

The use of flumazenil in a neonate.

Side effects of benzodiazepines used during pregnancy are described in a neonate. Recurrent apnea was reversed after administration of flumazenil, a specific antagonist of benzodiazepines.

[Methemoglobinemia after accidental Nestosyl ingestion]. / Méthémoglobinémie après ingestion accidentelle de Nestosyl.

Nestosyl is usually used for dental pain in children. We report a methemoglobinemia after accidental ingestion of 10 ml in a 2 year-old girl. Cyanosis was cleared and O2 saturation and PaO2 were normalized 15 mn after methylene blue (1 mg/kg) administered intravenously. Nestosyl contains butoform, benzocaine, resorcine and 8-hydroxyquinoleine: the 3 latest can induce methemoglobinemia. The benefit of the drug is not demonstrated and this potentially severe side effect justifies its delivery only after medical prescription and information about its dangers.

[Effect of aztreonam on the fecal aerobic flora in children]. / Effet de l'aztréonam sur la flore fécale aérobie de l'enfant.

Aztreonam, a new monobactam, has a spectrum limited to Gram negative aerobic bacilli. To evaluate its effect after parenteral administration on aerobic stool flora (Gram negative bacilli, Streptococci D, Staphylococci, Candida), quantitative cultures used serial dilution of stools twice a week on selective media. For Gram negative bacilli, agar dishes containing aztreonam or not were used. Colonies of different morphologies were counted. Representatives of each morphological type were then picked for identification and susceptibility tests. Among the 16 patients treated, 12 were decontaminated for aerobic gram negative bacilli by the 3rd day. Sensitive bacteria persisted in 4 cases, although at a low level. Resistant bacteria (Enterobacter cloacae and Acinetobacter) appeared at a "normal" level in 2 patients initially decontaminated. No dramatic change could be detected for Streptococci D, Staphylococci and Candida. In twelve additional infants neither hospitalized nor treated, no aztreonam resistant Gram negative bacilli could be found.

[Polymorphic atrial tachycardia and Wolff-Parkinson-White syndrome in a newborn infant]. / Tachycardie auriculaire polymorphe et syndrome de Wolff-Parkinson-White chez le nouveau-né.

The authors report a case of polymorphic supraventricular tachycardia in a premature neonate born at 33 weeks by caesarean section because of foeto-placental insufficiency and hydramnios due to foetal tachycardia diagnosed in utero. This arrhythmia was of interest because of the association of chaotic atrial tachycardia and the Wolff-Parkinson-White syndrome (WPW), which has rarely been described in the neonate. The mechanism of atrial tachycardia in the WPW syndrome is variable. In our case, there was retrograde atrial activation by the accessory pathway with atrial desynchronisation aided by left atrial dilatation. Digoxin, an effective anti arrhythmic agent in neonatal tachycardia, should not be used in cases of atrial tachycardia associated with ventricular preexcitation because of the risk of dangerous ventricular tachycardia.