[Effects of age on causes of hospitalization in children suffering from sickle cell disease]. / Causes d'hospitalisation des enfants drépanocytaires: influence de l'age (C.H.U. de Brazzaville, Congo).

The objective of this work was to assess the frequency the nature of complications and prognosis of the disease in children suffering from sickle cell disease. This retrospective study was conducted from January 2002 to December 2003 among 251 children suffering from sickle cell disease, hospitalized at the Brazzaville Teaching Hospital, Congo. The main hospitalization causes were dominated by the vaso-occlusive crisis (26.7%), anaemic crisis (20.3%) and infections (36.6%). The vaso-occlusive crisis were observed particularly in the 5 year-old children (p < 0.05); the hand-foot syndrome concerned in particular children under 5 years old. Anaemic crisis were found almost exclusively in patients under 5 (p < 0.05). The infections in children under 5 (35.8%) were almost as frequent as in older children (37.4%). Some non infectious complications were only observed in children above 5: cholithiasis, 4 cases; heart failure, 4 cases; hip osteonecrosis, 1 case. Global mortality was 4.8% and higher in children under five (p > 0.05). In addition, the death causes were dominated by anaemic crisis. In conclusion, this study stresses on the need to implement a primary prevention as well as a secondary prevention adapted to age.

[Vitamin D status in Gabonese children]. / Statut et besoins en vitamine D chez le nourrisson au Gabon.

OBJECTIVE: To analyse the status of vitamin D and the influence of a supplement of vitamin D in neonates and infants during the first 6 months of life in the african equatorial environnement of Gabon. DESIGN: Clinical (weight, height, head circumference, and diseases) and biological (calcemia, phosphatemia, serum alkaline phosphatase activity and plasma 25-hydroxyvitamin D levels) parameters were compared between 2 groups of children: group 1: 41 infants receving a daily supplement of 1000 IU of vitamin D, and group 2: 38 infants without vitamin D supplement. RESULTS: No significant differences were observed between the 2 groups concerning clinical and biological parameters. In particular plasma levels of 25-hydroxyvitamin D were normal and similar in both groups. CONCLUSION: A vitamin D supplement appears to be useless in 0 to 6 months infants living in Gabon.

Natural outcome of Helicobacter pylori infection in asymptomatic children: a two-year follow-up study.

BACKGROUND AND OBJECTIVES: It is known that Helicobacter pylori can be acquired in early childhood. There is not enough data to know whether or not infected children should be treated. A better knowledge of the natural outcome and implications of H pylori infection may provide evidence that eradication therapy is beneficial in childhood. This prospective study looks at clinical symptoms, endoscopic, microbial, and histologic changes during a 2-year period in infected asymptomatic children. It is hoped that some prognostic indicators will be found that select out the children that later need therapy. PATIENTS AND METHODS: During epidemiologic study of the prevalence of H pylori infection, 18 children aged 7 +/- 4 years (mean +/- 1 SD) were discovered to have H pylori infection and enrolled in the 2-year follow-up study. These patients had received no eradication therapy because they were asymptomatic. The follow-up for each patient consisted of an initial assessment, a clinical examination every 6 months, and an endoscopic reevaluation at the end of the first and second years. Gastric mucosal samples were analyzed for bacteriologic and histologic changes. Various factors were initially recorded: individual factors included sex, age, and housing conditions; microbial factors included bacterial load and the presence of the CagA gene. Inflammatory changes were also noted, such as the presence of active gastritis and nodular formation, and these were correlated with the histology which was described using the Sydney classification. Typing polymerase chain reaction-restriction fragment length polymorphism was performed to check the persistence of the same strain of H pylori in each patient. RESULTS: All of the children were still infected after 2 years with the same strain as in the initial assessment with the exception of 1 child whose infection cleared spontaneously. The density of antral and fundal mucosal colonization with H pylori also remained stable. There were progressive inflammatory changes in this cohort, particularly between the first and second year (histologic score, 3.5 +/- 1.3 vs 5 +/- 1). Active antral gastritis occurred in 3 out of 14 and 1 out of 8 children during the first and second year, respectively. Gastritis became active in the fundus in 2 out of 14 and 2 out of 8 children during the same period. Increases in the histologic score were found particularly in male children, and children colonized by cagA- strains of H pylori during the follow-up. The frequency of nodular gastritis significantly rose from 11% (2 out of 18 children) to 64% (9 out of 14 children) after 1 year, and to 80% (8 out of 10 children) after 2 years. CONCLUSION: These findings demonstrate a deterioration in the histologic features of the gastric mucosa of infected children despite stable H pylori colonization and the absence of symptoms.

[Severe malaria associated with acute renal insufficiency: apropos of a case]. / Paludisme grave associé à une insuffisance rénale aiguë: à propos d'une observation.

Renal insufficiency as a complication of severe malaria is a rare pathology. A case was observed in young girl aged 10.5 years following Plasmodium malaria fever. Clinical features included severe anemia, oligo-anuria, and creatinemia of 80 mg/l. The haemoglobin electrophoresis was standard. Under furosemide, the resumption of diuresis was effective nine days later. Renal functions of the child affected by severe Plasmodium malarial fever must always be checked.

[Neonatal esophago-gastro-duodenoscopy. Apropos of 123 examinations performed on 107 newborn infants]. / L'oesogastroduodénoscopie néonatale. A propos de 123 examens réalisés chez 107 nouveau-nés.

UNLABELLED: Upper gastrointestinal endoscopy is frequently used in the neonatal period. The aim of this study was to assess the frequency of the different lesions occurring as well as to precise indications of upper gastrointestinal endoscopy in neonates. POPULATION AND METHODS: A retrospective study including 107 neonates referred between October 1986 and April 1995 has been achieved in the pediatric gastroenterology unit of the Lille University Hospital. Various factors were analysed: gestational age, sex, reasons for endoscopy and macroscopic lesions observed. Three groups were constituted according to macroscopic findings; group I: normal aspect (n = 22); group II: isolated esophagitis (n = 27); group III: esogastritis or gastroduodenitis or esogastroduodenitis (n = 38). Chi 2 test was performed for statistical analysis. RESULTS: Signs recalling esophagitis (cry during feeding) were more frequent in group II than in group III: 37% vs 13% (P < 0.03). The neonates undergoing endoscopy for life-threatening events were more frequent in group I than in group II or III, respectively: 59% vs 15% (P < 0.01) and 59% vs 8% (P < 10(-4). Upper gastrointestinal endoscopy led to a precise diagnosis in 80% of the neonates. However 95% of those examined for hematemesis presented macroscopic lesions. CONCLUSIONS: Hematemesis and suspicion of esophagitis are good indications for upper gastrointestinal endoscopy in neonatal period. In life-threatening events and suspicion of pyloric stenosis, upper gastrointestinal endoscopy is only complementary of more contributive other examinations.

[Use of double-lumen umbilical vein catheters in a neonatal intensive care unit]. / Utilisation de cathéters veineux ombilicaux double voie en unité de soins intensifs néonatals.

BACKGROUND: The aim of the study was to compare the success/failure rate and complications of insertion into the umbilical vein, of either double-lumen catheters (Charrière diameter 04, length 13 and 30 cm) or single-lumen catheters (Charrière diameter 05, length 40 cm) in a population of neonates admitted to a neonatal intensive care unit. The numbers of insertions of additional peripheral venous catheters were also compared. PATIENTS AND METHODS: The population was divided into two groups according to the severity of the respiratory failure. Group 1 (n = 52): normal hemodynamic parameters and moderate respiratory failure (FiO2 < 0.6): only single-lumen catheters were used. Group 2 (n = 56): low systemic pressure requiring vascular filling and/or inotropic drugs infusion and/or severe respiratory failure (FiO2 > 0.6): in this group, either single-lumen catheters or double-lumen catheters were inserted. RESULTS: The success rate of insertion of double-lumen catheters and of single-lumen catheters were similar (61% vs 71%: P = 0.7). Nineteen double-lumen catheters were inserted in the group 2. The average duration of double-lumen umbilical catheterization was not significantly different from simple-lumen catheterization (4.9 +/- 2.2 vs 4.6 +/- 2.2 days). Complications relating to the umbilical venous catheterization were uncommon: three catheter obstructions (two with single-lumen catheter, one with double-lumen catheters), two nosocomial infections (both with single-lumen catheter), one hydropericardium (with single-lumen catheter). In group 2, more peripheral venous catheters were required during the first 72 hours of life after insertion of single-lumen catheter than after insertion of double-lumen catheters (average number of peripheral venous catheters per infant: 1.6 +/- 0.83 vs 1 +/- 0.35 respectively; P < 0.01). CONCLUSION: Feasibility and complication rate of umbilical double-lumen catheters were similar to those of single-lumen catheters. The use of umbilical double-lumen catheters reduces the need of peripheral venous catheters.

[Long-term follow-up of children with esophageal caustic stenosis]. / Evolution à long terme des sténoses caustiques de l'oesophage de l'enfant.

BACKGROUND: Long term follow-up of children with esophageal caustic stenosis is not well known. The aim of the present study was to describe functional, organic and psychological, as well as social consequences. PATIENTS AND METHODS: Thirty-four children with a mean age of 3 years and 7 months +/- 3 years and 2 months (ranges: 1 month-14 years and 3 months) were included in a longitudinal study. Various parameters have been studied: treatment, functional symptoms, nutritional status (weight/height, body composition) and psychological and social consequences. chi 2 and Mann-Whitney tests were used for statistical analysis. RESULTS: Twenty-one patients have been treated by mechanical dilatations whereas surgery was performed in 12 children; the mean number of dilatations per child was higher in patients treated by dilatations (21 +/- 17 vs 14 +/- 16; P < 0.05). The frequency of dysphagia was not different in patients with colon interposition or not (69% vs 53%; P = 0.1). Nutritional status was not affected by the presence of esophageal caustic stenosis. Psychological and social consequences were characterized by scholastic difficulties, anxiety and severe depression. One case of suicide was observed. CONCLUSION: Children with caustic stenosis should be followed for a long period of time. A multidisciplinary approach is necessary, taking into account medical, social and psychological consequences.

[Is Ambu ventilation of newborn infants a simple question of finger-touch?]. / La ventilation à l'Ambu chez le nouveau-né: une simple question de doigté?

Insufflation pressures were measured during manual ventilation using a neonatal rebreathing bag (Ambu on a manikin. Maximal insufflation pressures were greater than that published or given by the manufacturer, theoretically limited to 30 cm of water at open valve, and that whatever the number of fingers used for the compression of the bag. These results indicate that Ambu ventilation, often mandatory for newborn resuscitation, does not simply rely upon the finger-touch of the operator and that it always has a risk of baro and/or volotraumatism.

[Risk factors of intrauterine growth retardation in Congo]. / Facteurs de risque de retard de croissance intra-utérin au Congo.

A case-control study was performed between April 1st and September 30th to investigate determinants of intrauterine growth retardation (IUGR) in 3 centers in Brazzaville, Congo. Each patient group included 539 neonates. Cases were newborns with birth weight below the 10th percentile of the Leroy and Lefort curve. Risk factors of IUGR identified with univariate analysis were: maternal age<20 years, low educational level, unmarried woman, low social and economic status, primiparity, low birthweight of previous child, low interpregnancy interval, number of prenatal examinations<4, maternal weight gain during pregnancy<5kg and malaria. Multivariate analysis retained 3 risk factors: low educational level, low social and economic status, and maternal weight gain during pregnancy<5kg. This study enabled us to identify certain risk factors of IUGR useful for establishing a prevention strategy.

[Tracheal atresia: apropos of 2 cases]. / L'atrésie trachéale: à propos de deux observations.

Two cases of tracheal atresia are reported. This is a rare malformation which is responsible of neonatal respiratory distress, lack of cry at born and difficulties to put a tube inside the trachea. Various malformative abnormalities are commonly associated to tracheal atresia. The death occurred in these two newborns some days after birth. Tracheal atresia is a common lethal malformation.

[Pseudohypoaldosteronisme type I: a rare cause of failure to thrive]. / Une cause rare de stagnation pondérale à la naissance : le pseudohypoaldostéronisme de type I.

We report on a boy, born on term, presenting with a weight loss and a persistent failure to thrive after 10 days despite a normal behavior under bottle-feeding. The clinical examination was normal and biological assessment revealed hyponatremia with hyponatriuria, normal kaliemia and elevated aldosterone values, leading to type I pseudohypoaldosteronism diagnosis. Treatment with salt supplementation allowed growth improvement. The diagnosis was confirmed by the identification of a mutation in the mineralocorticoid receptor. This change was also found in several family members.