[Severe bacterial infections in children. Survey by the pediatric mobile intensive care unit AP/HP in the Ile-de-France area]. / Infections bactériennes graves de l'enfant. Enquête des SMUR pédiatriques AP/HP de l'Ile-de-France (de 1998 au 1er quadrimestre 2001).

This study involves 106 infants (neonatal period ruled out), victims of severe bacterial infections managed from 1st january 1998 to 30 April 2001 by the four paediatric Mobile Intensive Care Unit (P.M.I.C.U.) teams AP-HP in Ile-de-France area. 46.2% of the whole infants are primary interventions (home, medical room, airport) and primary-secondary interventions (hospital emergencies) whereas 53.8% are related to secondary transports of infants who have been hospitalized and suffered from severe bacterial disorders complicating their original disease. 51% are meningitidis infections, rather due to streptococcus pneumoniae and meningococcis, associated with severe infectious purpura. 20.75% are toxic shock syndromes in patients suffering from chronic affections (sickle cell anemia), acquired or congenital immunodeficiencies; 19.8% of the cases are severe bacterial pneumonia (staphylococcal pleuro-pneumopathies, bordetella pertussis cough) or surinfected viral infections (VRS bronchiolitis, pneumonia due to mycoplasma pneumoniae and para-influenzae III). Authors study various characteristics of the two patient's groups, their immediate management by local medical team and by the P.M.I.C.U. team, their early term outcome. 65% of children recovered apparently without sequelae, 19% died, and 16% healed but with significant sequelaes, notably neurological damage. Meningitidis due to Streptococcus pneumoniae are particularly severe, because of their prognostic (10 deaths, 8 severe sequelae among the 26 cases). These observations prompted us to recommend early immunization of infants at 2-3 months post natal age by the new vaccine conjugated up to 7 valences such as "Prevenar". If this vaccine have been available for this patient series, may be avoided 8 deaths, 7 severe sequelae, with 1 septic shock syndrome due to streptococcus pneumoniae and another serious infection in a homozygous sickle cell disease.

[Non-invasive methods of respiratory monitoring during resuscitation in neonatal and pediatric care]. / Méthodes non invasives de surveillance de la respiration en réanimation néonatale et pédiatrique.

The authors review the non-invasive methods currently used in paediatric intensive care units to monitor the oxygenation and ventilation of neonates and infants. They deal successively with the qualities and defects technique (transcutaneous measurement of PO2, SaPO2 and PCO2) and with the usefulness of capnography. These various methods of investigation and monitoring must complete each other to ensure the safety of children in situations of distress.

[Emergency medical transport of children in the Ile-de-France area]. / Les transports médicalisés urgents en pédiatrie dans la région Ile-de-France.

Pediatric emergency medical service is available since 1976 in France. Presently, 4 such services are available in the Paris area for neonatal and pediatric emergencies. Coordination of these services was established in 1980, to establish a close collaboration between the various medical teams by linking them in a synergic way. This resulted, in 1985, in 6,740 transports of children, 83% of which in an emergency. Neonatal pathology accounted for 70% of the transports and 53% of transported children required assisted ventilation. The importance of these pediatric emergency services, their specificity and their level of technicality suggest that they contributed to the decrease of the pediatric and neonatal morbidity and mortality recorded in the past decade.