RESUMO
UNLABELLED: Neonatal early-onset infection has been recognized as a significant cause of perinatal mortality and morbidity, in spite of recent improvement in perinatal care. In France, Anaes guidelines were published in 2002. OBJECTIVES: To evaluate paediatricians' knowledge about these official guidelines in Lille's perinatal network. MATERIALS AND METHODS: Every network's paediatrician, working in a hospital maternity or in a neonatology unit received a questionnaire, to evaluate his knowledge about early onset sepsis diagnosis, indication and type of per partum antibiotherapy, and immediate neonatal care, according to perinatal factors. RESULTS: Response rate was 55%. Thirty-five per cent of paediatricians underestimated gastric sample's diagnostic role and 41% prescribed a triple antibiotherapy. Duration of antibiotic treatment was too long in 56% of cases. Biologic tests were prescribed in excess in 71% of cases when a streptoccocal B mother's colonization was present. Per partum antibiotherapy was appropriated in only 29% of responses. CONCLUSION: This study underlines imperfect official guidelines' knowledge, leading to ecological, bacterial, and economical consequences.
Assuntos
Competência Clínica , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Sepse/diagnóstico , Sepse/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , França , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Padrões de Prática Médica , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Severe falciparum malaria is a polymorphous life-threatening disease. Hyperparasitemia is rare among non-immune children returning from tropical areas. CARE REPORT: We report a case of an infant returning from Ivory Coast who presented with fever, prostration and marked thrombocytopenia (22,000 platelets/mm(3)). Blood slide showed Plasmodium falciparum ring forms. Parasite density dramatically increased from 1.7% to 45%, and the child developed several features of severe malaria, according to WHO definition. CONCLUSION: In this non-immune infant, prostration and thrombopocytopenia seemed to be earlier predictors of severity than hyperparasitemia and other WHO criteria, which have not been yet validated in travelling children.
Assuntos
Malária Falciparum/parasitologia , Parasitemia/parasitologia , Plasmodium falciparum/isolamento & purificação , Animais , Antimaláricos/uso terapêutico , Humanos , Lactente , Malária Falciparum/complicações , Malária Falciparum/tratamento farmacológico , Masculino , Parasitemia/tratamento farmacológico , Quinina/uso terapêutico , Convulsões Febris/parasitologia , Trombocitopenia/parasitologia , Viagem , Resultado do TratamentoRESUMO
Serum C-reactive protein (CRP) values were obtained in 24 children with infectious purpura: 8 were not shocked and survived, 10 were shocked and survived, 6 were shocked and died. On admission, mean CRP levels were significantly lower (P less than 0.001) in shocked patients who died (69 +/- 27 mg/l) than in shocked patients who survived (209 +/- 60 mg/l). In shocked patients the predictive value for death of a CRP level below 100 mg/l was 83%. The predictive value for survival of a CRP level above 100 mg/l was 90%. Steadily high values of CRP beyond the 8th day seem to be related to severe necrosis rather than to an unsuccessful treatment or superinfection.
Assuntos
Infecções Bacterianas/sangue , Proteína C-Reativa/análise , Púrpura/sangue , Infecções Bacterianas/mortalidade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Prognóstico , Púrpura/microbiologia , Púrpura/mortalidade , Fatores de TempoAssuntos
Proteína C-Reativa/metabolismo , Meningite Meningocócica/classificação , Púrpura/classificação , Choque Séptico/classificação , Criança , Pré-Escolar , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica , Masculino , Meningite Meningocócica/complicações , Meningite Meningocócica/mortalidade , Meningite Meningocócica/terapia , Valor Preditivo dos Testes , Prognóstico , Púrpura/complicações , Púrpura/terapia , Índice de Gravidade de Doença , Choque Séptico/complicações , Choque Séptico/mortalidade , Choque Séptico/terapiaAssuntos
Criança Hospitalizada , Estado Nutricional , Adolescente , Criança , Pré-Escolar , França , Hospitais , Humanos , Lactente , Estudos ProspectivosRESUMO
An 8-year-old boy with bacterial tracheitis, treated by endotracheal intubation, humidification, airway toilet and antibiotics, experienced a toxic shock syndrome on the day after his admission. The course was favourable. Staphylococcus aureus was isolated from tracheal secretions. Bacterial tracheitis is an infrequent cause of non-menstrual toxic shock syndrome. The diagnosis of bacterial tracheitis should be suspected in a child with toxicity and croup who is not responding to the usual therapy. Endoscopy should be performed allowing for removal of the secretions. The maintenance of a clear airway is the main purpose of the treatment.
Assuntos
Crupe/patologia , Laringite/patologia , Choque Séptico/patologia , Infecções Estafilocócicas/patologia , Criança , Crupe/complicações , Humanos , Masculino , Choque Séptico/etiologia , Infecções Estafilocócicas/complicaçõesRESUMO
We report the first case of Haemolytic-uraemic syndrome (HUS) associated with Streptococcus pneumoniae meningitis. This supports a common pathogenic mechanism in HUS following infections by neuraminidase-producing organisms and in pneumococcal meningitis. We recommend that HUS must be considered in cases of renal failure and/or anaemia associated with pneumococcal meningitis, and that bacterial meningitis be considered in all patients with HUS and central nervous system involvement.
Assuntos
Síndrome Hemolítico-Urêmica/complicações , Meningite Pneumocócica/complicações , Humanos , Lactente , Masculino , Neuraminidase/metabolismo , Streptococcus pneumoniae/enzimologiaRESUMO
A case of chronic vitamin A intoxication is reported in an infant under 6 months of age. The features included hydrocephalus, usually described in acute hypervitaminosis A and the other cutaneous, hepatic and skeletal signs observed in chronic intoxication.
Assuntos
Hidrocefalia/induzido quimicamente , Hipervitaminose A/complicações , Fosfatase Alcalina/sangue , Doença Crônica , Edema/induzido quimicamente , Hepatomegalia/induzido quimicamente , Humanos , Hipercalcemia/induzido quimicamente , Lactente , Masculino , Vitamina A/administração & dosagemRESUMO
Plasma fibronectin levels were determined in 34 children admitted with severe infectious purpura. Fibronectin concentration was decreased in severe infectious purpura as in other sepsis, but there was no significant difference between shock and nonshock patients. Fibronectin levels were lower in children with ecchymotic or necrotic purpura on admission than in those with petechial purpura; they were lower in those who developed cutaneous sequelae, but it is not known if correction of fibronectin deficiency may limit the extent of purpura and prevent the cutaneous sequelae.
Assuntos
Fibronectinas/sangue , Púrpura/sangue , Criança , Pré-Escolar , Fibronectinas/deficiência , Humanos , Lactente , Prognóstico , Púrpura/complicações , Choque/sangue , Choque/complicaçõesRESUMO
The authors report a case of tetanus in a 19 months infant who has only received BCG. After a four days period during which two laryngeal spasms occurred, the infant presents a generalized tetanus. The outcome was favorable with specific serotherapy myorelaxants and assisted ventilation of four weeks duration.