[Respiratory distress in three newborns after mask disinfection with Endosporine. Probable role of glutaraldehyde]. / Détresse respiratoire chez trois nouveau-nés après désinfection des masques par l'Endosporine. Rôle probable du glutaraldéhyde.

BACKGROUND: Disinfectants for medical devices are uncommonly a cause of iatrogenic adverse effects. Nevertheless, when misused, they can induce severe complications. Three cases of acute respiratory distress in newborns probably induced by glutaraldehyde are reported. CASE REPORTS: Three children born by Caesarean section between 8 and 19 May 1999 in the same hospital presented acute respiratory distress requiring hospitalization in the neonatal intensive care unit; one child was premature. The clinical appearance, which was initially normal, deteriorated with a respiratory distress in 30 to 60 minutes. Recovery was uneventful in all cases. The diagnosis considered was a hyaline membrane disease. The enquiry conducted after this cluster onset identified, as a main contributing factor, the disinfection procedure recently introduced in the surgical theater. CONCLUSION: Review of toxicologic data on glutaraldehyde shows this is a highly irritating chemical for the respiratory tract, even at low concentrations. Clinical and radiologic features in these three neonates are compatible with a pulmonary sub-edema on an immature alveolar setting. The hypothesis proposed is that glutaraldehyde, the active ingredient of the biocidal formula used to disinfect the respiratory masks, was massively desorbed from the rubber and foam of which masks are made.

[Clinical, pharmacokinetic and therapeutic study of amikacin with single daily dose and in combination in neutropenic children with fever]. / Etude clinique, pharmacocinétique et thérapeutique de l'amikacine en dose unique journalière et en association chez l'enfant neutropénique fébrile.

BACKGROUND: The efficacy of single daily dose of amikacin has been recently demonstrated in neutropenic children with fever. POPULATION AND METHODS: Eighteen children aged 1 to 15 years were included in the study. All patients were febrile and granulocytopenic and had indwelling intravenous catheter. Amikacin was administered as a 30-minute intravenous infusion once daily (20 mg/kg on day 1, then 15 mg/kg) for 3 to 30 days; the patients received amikacin in combination with piperacillin and vancomycin. Serum levels of amikacin were measured on days 1, 3, 6 and 10, and 30 min, 60 min and 180 min after the end of the infusion. RESULTS: All patients responded favourably to the antibiotic therapy. Sixty-two kinetics were performed: peak amikacin concentrations measured (30 min after 30-min infusion) on day 1 averaged 43.7 micrograms/mL (+/- 13.8). A significant increase in peak serum concentrations was observed during the treatment (day 3 vs day 10) without change in the trough serum concentrations. The volumes of distribution were considerably important in these granulocytopenic children and there was a large inter and intra-patient variability; the elimination half-life of the amikacin was short (1.45 h). There was no significant nephrotoxicity in any patient. CONCLUSION: The use of single daily dose amikacin in combination with a broad spectrum beta-lactam antibiotic and vancomycin was efficient and safe in febrile granulocytopenic children. The simulation of the amikacin behaviour in the deep compartment should be evaluated; in fact, it might reflect better accumulation of the drug than serum concentrations.

[Bioavailability and bone toxicity of barium chloride by chronic administration in rats]. / Biodisponibilité et toxicité osseuse du chlorure de baryum en administration chronique chez le rat.

Knowing long term total parenteral nutrition (TPN) can bring 12 micrograms/kg/day as barium contamination, we investigated the barium ability to give the same bone toxicity as observed in patients' underlying TPN. A preliminary study carried out on 21 rats allowed us to calculate the bioavailability of barium chloride (50%) with doses fixed at 1 mg/kg for the intravenous route and 10 mg/kg for the oral route. As it is very difficult to feed rats parenterally for more than 30 days, we decided to give barium chloride orally. Twenty rats received 48 micrograms/kg/day barium chloride during 4 months. The barium plasma and bone levels were not statistically different between the control group and the tested group. The femurs and tibias were removed for analysis, carried out by different fixation and coloration techniques. No anomalies could be detected in the treated group concerning main bone parameters that are disturbed in patients' underlying TPN.

[Evaluation and validation of controls of aerobiocontamination in the prevention of nosocomial invasive aspergillosis]. / Evaluation et validation de contrôles d'aérobiocontamination dans la prévention d'aspergilloses invasives nosocomiales.

Further to an invasive epidemic pulmonary aspergillosis, occurred in an onco-hematologic pediatric unit, an emergency plan has been organised and prophylactic precautions has been taken. The authors have retrospectively analysed the results concerning the aerial contamination. The authors have evaluated the efficacy of these prophylactic precautions. Their good results allow them to validate cleaning, disinfection and surveillance protocols.