[Cor triatriatum sinister: unusual cause of neonatal respiratory distress]. / Coeur triatrial gauche: une cause inhabituelle de détresse respiratoire néonatale.

We report the case of a newborn presenting with neonatal respiratory distress due to acute pulmonary edema, the underlying diagnosis being cor triatriatum sinister. This rare anomaly can be lethal in the short term. However, it can be completely cured surgically provided that diagnosis is made on time.

Conservative management of patent ductus arteriosus in preterm infants.

We report our experience of medical treatment, chiefly based on prolonged artificial ventilation, of 33 preterm infants with PDA and heart failure whose survival rate was 88%. All of them had clinical criteria used by others to indicate surgical ligation of the ductus arteriosus. This conservative approach seems to give better results than surgical ligation, despite a high frequency of bronchopulmonary dysplasia among survivors.

Pulmonary haemodynamics after surfactant replacement in severe neonatal respiratory distress syndrome.

Aortopulmonary pressure difference and pulmonary blood flow velocity were studied during the first 48 hours of life in 12 premature neonates with severe respiratory distress syndrome (RDS), treated by natural surfactant, and in 25 premature neonates with mild RDS. A non-invasive Doppler ultrasound method was used to estimate aortopulmonary pressure difference and pulmonary blood flow velocity from the left pulmonary artery. Aortopulmonary pressure difference was significantly lower at 6 hours of age in the infants with severe RDS and was not increased one hour after surfactant therapy. Aortopulmonary gradient started to rise at 24 hours of age and was equal to that of neonates with mild RDS at 48 hours. Pulmonary blood flow velocity was significantly lower, initially in the severe RDS group, and was not increased one hour after surfactant therapy. Left pulmonary artery flow velocity began to rise after 24 hours and reached the values of the mild RDS group at 48 hours. These data indicate that aortopulmonary pressure difference and pulmonary blood flow are low in the acute phase of RDS and that surfactant treatment does not seem to affect these values.

[Congenital variant of type IV glycogenosis. Anatomoclinical report of a case]. / Glycogénose type IV variante congénitale. A propos d'une observation anatomo-clinique.

Type IV glycogenosis or Andersen disease is characterized by a deficiency in branching enzyme. This rare disease is exceptionally seen at birth. The clinico-pathological data are then typical: severe hypotonia with hypoventilation and cellular storage, without any hepatosplenomegaly. The stored material is PAS positive, sometimes made of crystals and appeared birefringent under polarized light. Granulo-filamentous inclusions are shown by electron microscopy, essentially observed in muscle and liver without cirrhosis. Death occurs rapidly. The present case was typical. It is the eleventh reported case in the literature.

[Decompensation in chronic respiratory insufficiency in children]. / Décompensation au cours de l'insuffisance respiratoire chronique de l'enfant.

In patients with acute exacerbations of chronic obstructive or restrictive pulmonary disease, noninvasive ventilation can be used in an attempt to avoid endotracheal intubation and complications associated with mechanical ventilation. The main obstructive pathology concerned is bronchopulmonary dysplasia: bronchial hyperreactivity is a main feature of the situation, leading eventually to acute or prolonged assisted ventilation. Usually performed by tracheostomy, ventilation can possibly be managed through a nasal mask. The use of noninvasive ventilation is also indicated when symptoms of hypoventilation and daytime hypercarbia develop in a variety of neuromuscular disorders.

[Retrospective study of 32 cases of intraosseous perfusion]. / Etude rétrospective de 32 cas de perfusion intraosseuse.

BACKGROUND: We studied all intraosseous infusions performed between 1994 and 1997 by the pediatric intensive care unit and by the pre-hospital emergency medical staff in the Hôpital d'Enfants, Toulouse, France. POPULATION AND METHODS: We report 32 cases of intraosseous infusions in 30 children aged 2 weeks to 9 years. RESULTS: In our population, such a technique has been used in about 60% of all cardiopulmonary arrest, drowning or traffic accident cases. Intraosseous infusion was successful in all cases, on the first attempt in more than 80% of cases. Nine children recovered without any sequelae. No major complications have been observed. CONCLUSIONS: Intraosseous infusion is safe, rapid and effective. It is an essential alternative route in pediatric resuscitation when no other venous access can be performed quickly. An effort must be made on behalf of its diffusion and teaching.

[Intraosseous infusion in children]. / Voie intraosseuse chez l'enfant.

OBJECTIVE: To assess the benefits and drawbacks of intraosseous infusion (IOI) for emergency therapy in children. STUDY DESIGN: Retrospective, non comparative study of IOI carried out between January 1994 and June 1998. PATIENTS: Forty-one children requiring without delay IOI either in the emergency medical ambulance or the emergency admission and intensive therapy units. METHODS: The tibia was punctured by paediatricians either with Mallarmé's trocars in 1994 or Cook Critical Care trocars from 1995 on. RESULTS: Overall, 46 IOI have been carried out in 41 children with a median age of 18 months (range: 8 days-9 years). The main indications for IOI were the management of near drowning, road traffic accidents and cardiopulmonary resuscitation. Complications included one articular puncture and nine subcutaneous extravasations, requiring the puncture of the other limb in five cases. CONCLUSION: IOI is an easy technique for vascular access. It is indicated in emergency cases when, after a delay of five minutes, other techniques have failed.

[Severe hydrogen sulfide intoxication: a pediatric case of survival]. / Intoxication accidentelle grave à l'hydrogène sulfuré: un cas pédiatrique de survie.

We report a paediatric case of survival following severe hydrogen sulfide (H2S) gas intoxication. A 13-year-old boy was found submerged to the neck in a manure tank. He was hypothermic, unresponsive with bilateral mydriasis, and had poor oxygen saturation. After intubation, he was transferred to the paediatric intensive care unit of a tertiary care children's hospital. He developed acute respiratory distress syndrome (ARDS) requiring high frequency percussive ventilation. Cardiac evaluation was significant for myocardial infarction and left ventricular function impairment. He completely recovered from the respiratory and cardiac failure. Neurological examinations showed abnormal signals on MRI in the semi-oval center and in the frontal cortex. Follow-up detected partial impairment of axonal fibers of the right external popliteal sciatic nerve. Paediatric cases of survival after H2S intoxication have been rarely reported. Such exposures can evolve to severe ARDS and benefit from high frequency percussive ventilation. Hypothermia and other metabolic abnormalities are now better explained thanks to actual knowledge about endogenous H2S function. Lessons learned from paediatric accidents should result in better information about this threat for farmers and families living in houses with septic tanks, reducing the risk to their own and their children's safety.

[Are convulsions on the fifth day of life a distinct clinical and electrophysiological entity? (author's transl)]. / Convulsions du 5e jour de vie. Entité électro-clinique?

A clinical and electrophysiological study was carried out on 20 children in hospital during the neonatal period and who experienced convulsions on the fifth day of life. The clinical and electrophysiological course has been similar and favourable in all cases. The aetiology and long term prognosis, however, remain unknown.

[Hemodynamic repercussions of a giant hemangioma treated by compression]. / Répercussions hémodynamiques d'un hémangiome géant traité par compression.

The authors report a case of giant hemangioma with thrombocytopenia, whose very important increase was responsible for acute congestive heart failure with pre-renal failure. In order to limit the tumoral volume, a compressive dressing was applied which had to be removed at first, as it had respiratory and hemodynamic consequences. A dressing was reapplied, and with concomitant diuresis obtained a dramatic improvement. The volemic changes observed in this case are discussed.

[Intra-osseous route. Administration route of drugs in cardiac arrest]. / La voie intra-osseuse. Voie d'administration des médicaments au cours de l'arrêt cardiaque.

We describe the case of a 6 month-old infant suffering from cardiac arrest and successfully resuscitated after epinephrine had been administered through the intraosseous route. During emergency care, vascular access is critical but may be very difficult in young children. Therefore intraosseous infusion appears to be a very efficient alternative for quick administration of drugs and fluids when vascular access is not easily obtained.

[Neonatal intestinal obstruction due to congenital hypothyroidism (author's transl)]. / Subocclusion néonatale par athyréose.

Three children with subacute neonatal intestinal obstruction are described in whom the diagnosis of congenital megacolon was suspected. The radiological changes improved when oral feeding stopped but reappeared when it was restarted. The aetiology remained unrecognised until the results of the neonatal screening for hypothyroidism showed all three cases had congenital hypothyroidism. The severity of the disorders was unusual and remains unexplained. Systemic TSH and/or T4 determinations should lead to a better understanding of the disorders due to hyperthyroidism in neonates.

[Neonatal renal papillary necrosis]. / Nécrose papillaire rénale néo-natale.

Renal papillary necrosis was detected early by plasma and urine analyses in a neonate with the respiratory distress syndrome. The intravenous urogram demonstrated characteristic features of the condition. Initial symptoms were polyuria, urinary salt loss and haematuria, but the only residual abnormality was a mild defect in urinary concentrating ability.

[Maternofetal deficiency hyponatremia caused by a selt-free diet during a multiple pregnancy]. / Hyponatremie maternofoetale carentielle par regime desode

Quadruplets born at 36 weeks gestation were severely hyponatraemic. The mother had been given a sodium deficient diet for the majority of pregnancy and she herself was also hyponatraemic with hyperaldosteronism. This patient illustrates the problems of sodium restriction during pregnancy and the need for its supervision.

[Neonatal hematemesis caused by peptic esophagitis]. / Hématémèses néonatales par oesophagite peptique.

Five full term neonates presented with haematemeses on one of the first three days of life. All but one had been given vitamin K at birth. Two out of five had clotting abnormalities that suggested vitamin K deficiency. All had evidence of hiatus hernia and, on oesophagoscopy, had evidence of peptic oesophagitis. Bleeding is another complication of neonatal peptic oesophagitis.

[Convulsions in the fifth day of life: a new syndrome?]. / Les convulsions du cinquieme jour de vie: un nouveau syndrome?

Among a series of 98 newborns who experienced neonatal seizures, 20 of them were individualized for they illustrated a "new syndrome": "the seizures of the fifth day of life". These patients were born at term, their maternal and natal history was unremarkable. Seizures always began around the fifth day and most often constituted a real electro-clinical état de mal. EEG reveals alternating sharpened theta waves, a pattern which seems to be characteristic. Some 6 days later, children recovered completely. Further evolution appeared to be always favorable. Although etiological enquiry remained negative, many facts suggested a viral etiology. This syndrome is probably frequent as it was also observed in other neonatal units.

[Cardiac tamponade secondary to umbilical venous catheterization accident in a premature infant]. / Tamponnade cardique secondaire à un accident de cathétérisme veineux ombilical chez un prématuré.

BACKGROUND: Cardiac tamponade is a rare and sometimes severe complication of umbilical venous catheterization. CASE REPORT: A premature newborn (gestational age: 30 weeks, birth weight: 1,215 g) required assisted ventilation and umbilical venous catheterization for respiratory distress. Subsequent chest X-ray showed the ascending tip of the catheter lying in the left atrium, inside the auricle. At the age of 16 hours, the infant presented with episodes of bradycardia. Despite a second endotracheal intubation, a sudden vascular collapse necessitated cardiac massage plus sodium bicarbonate and epinephrine. An ultrasound examination was performed because of the persistence of the vascular collapse; it showed a clear echo-free space between the epicardium and pericardium, suggesting pericardial effusion. The patient responded dramatically to pericardial aspiration, providing hemorrhagic fluid containing 20 g per liter glucose. DISCUSSION: Cardiac tamponade probably occurred in this patient as a result of perforation of the atrial wall. Ultrasonography showed no local thrombus, but confirmed the cardiac compression by pericardial fluid and the localization of the tip of catheter in contact with the atrial wall. This case led us to review the mechanical complications of umbilical venous and/or percutaneous catheterization and the rules for their use. CONCLUSION: This complication must be suspected in all patients having a central venous catheter that present with vascular collapse.