[Heat stroke and topiramate]. / Coup de chaleur et topiramate.

Heatstroke, which is a major disorder related to environmental hyperthermia, is a rare event in children. The risk is increased with predisposing medical conditions and specific medications. We report the case of a 10-year-old epileptic patient, who received topiramate. Topiramate causes hypohydrosis and hyperthermia. We suggest that topiramate treatment may be a risk factor for heatstroke.

[Medical aspects of commercial air travel]. / Aspects médicaux des voyages aériens commerciaux.

A high proportion of commercial plane passengers are children: two million fly every year on Air-France airlines. In this field, the physician can be called upon to authorize or prohibit travelling. He could take measures or offer his services at the request of the cabin staff. The authors review flight physiology and stress, their potential effects on healthy children or those with medical conditions, and their fitness to fly.

[Dietary water intoxication: a preventable pathology]. / Erreur diététique et intoxication par l'eau: une pathologie évitable.

CASE REPORT: The authors report the case of an infant presenting with status epilepticus, apneas and hypothermia, related to hyponatremia. The cause was water intoxication, secondary to feeding a dilute formula and free water. The parents were notoriously challenged by the care of their children. Such disorder could have been prevented. CONCLUSION: Dietary history may be key to the diagnosis of hyponatremia in children. Water intoxication of nutritional origin can be prevented.

[Morganella morganii and early-onset neonatal infection]. / Morganella morganii et infection maternofoetale.

UNLABELLED: Morganella morganii is an opportunistic gram-negative bacterium, resistant to ampicillin, and scarcely involved in early-onset neonatal sepsis. CASE REPORT: After a premature rupture of the membranes, a pregnant patient received prophylactic amoxicillin per os. She developed chorioamnionitis. Her infant was diagnosed with early-onset sepsis. Maternal and baby's blood cultures grew M. morganii. Both the mother and the infant were successfully treated with a third-generation cephalosporin and an aminoglycoside. DISCUSSION: The influence of a prior antibiotherapy on the emergence of M. morganii vertical infections is discussed.

Prenatal transmission of dengue: two new cases.

Dengue is commonly observed in most tropical countries, but its transmission from mother to fetus has not been frequently described. We report two such cases. The first signs of dengue in the infants appeared on the 3rd and 9th days of life. In both, a bacterial infection was suspected initially. In areas where it is endemic, the diagnosis of dengue should be considered in the neonate with signs of bacterial infection. When dengue is suspected in a pregnant woman, laboratory investigation and extended observation of the newborn are advised.

[Congenital syphilis still exists]. / La syphilis congénitale n'a pas disparu.

INTRODUCTION: Even today screening for congenital syphilis must be performed and confirmed by appropriate serological tests and bacteriological samples. OBSERVATION: A newborn presented with an apparently materno-fetal or viral fetal disease. It was in fact congenital syphilis. The mother exhibited no risk factors for syphilis. Systematic serological search for syphilis was negative in the mother at 11 weeks of amenorrhea. No signs of primary or secondary syphilis had been observed during pregnancy. At twenty-nine weeks of amenorrhea, the mother presented a menace of preterm delivery and no tocolysis at 31 weeks. Examination of the newborn revealed clinical signs of aterno-fetal infection, without specificorientation. Initial bacteriological and virological analyses were negative. Screening for specific Treponema pallidum M-type immunoglobulines (IgM) on the 9th day of life, confirmed the diagnosis of congenital syphilis. COMMENTS: Diagnosis of congenital syphilis must not be eliminated during early serological screening: clinical suspicion must lead to further anamnesis again and serological tests both in the newborn and the mother.

[Use of the intraosseous route in a premature infant]. / Utilisation de la voie intraosseuse chez un prématuré.

BACKGROUND: The intraosseous route (IOR) is a rehabilitated vascular access in emergency situations. Its indications and duration are defined, although the age limit at which it is usable is not clearly established. CASE REPORT: A 34-week-old preterm neonate, without infection, receiving gastric gavage, developed, at 8 days of life, a severe septic shock requiring ventilatory support and emergency volume expansion via a subclavian catheter. During the chest X-ray to check its position, the catheter was unfortunately pulled out. The child presented an acute desaturation with bradycardia, requiring bag ventilation and endotracheal epinephrine. The umbilical vein being unusable, an intraosseous access (20 G, distal hole, Cook) was performed at the upper tibial level to continue resuscitation and left in place for 14 hours to infuse antibiotics, inotropic support, blood products and colloids. Blood cultures grew Klebsiella pneumoniae. After a severe initial phase, course was favorable with normal examination at 3 years without complication of the IOR. DISCUSSION: To our knowledge, it is the youngest child in whom IOR was performed. For neonates and especially preterms, the site of puncture is just below the tibial superior tuberosity, otherwise there is a risk of fracture of the diaphysis. This risk justifies the control of the IOR by X-ray. The place of the IOR among emergency vascular accesses in neonates, seems to us to be reserved to situations when umbilical vein is unusable. CONCLUSION: Although no study compared IOR to superior longitudinal sinus access, we suggest to reserve the sinus access only when IOR has failed, because of its potential cerebral complications.

[Cytomegalovirus, pregnancy and occupational risk]. / Cytomégalovirus, grossesse et risque professionnel.

BACKGROUND: Female health professionals are not more likely to contract cytomegalovirus (CMV) infection than the general population. CASE REPORT: Generalized congenital infection was diagnosed in a neonate. His mother was a nurse working the 2 first trimesters of her pregnancy in close-contact with AIDS patients chronically infected with CMV. CONCLUSION: Preventive measures to avoid CMV transmission among health-care professionals are controversial. The only guideline actually receiving universal agreement consists of standard hospital measures of hygiene.

[Neurologic manifestations in a child of a mother with gestational herpes]. / Manifestations neurologiques chez un enfant de mère atteinte d'herpès gestationis.

BACKGROUND: Herpes gestationis in the neonate is usually associated with an increased risk of premature birth and/or low birth weight for gestational age (GA) and sometimes skin lesions. Neurologic manifestations are nos described in these babies. CASE REPORT: A boy was born at 35 weeks of GA from a mother who developed skin eruption typical of herpes gestationis. His weight was 2320 g and his height was 46 cm. He had transient respiratory distress syndrome and was given antibiotics due to suspected group B streptococcus infection. He developed on day 3 skin vesiculous eruption which disappeared within 3 days and neurologic manifestations: hypertonia and hyperkinesis, abnormal EEG. The CSF was normal. The manifestations spontaneously disappeared within 5 days. The herpes gestationis factor was present in both mother and infant. CONCLUSION: A relationship between the maternal herpes gestationis and neonatal neurologic manifestations is possible; there was no other known causes for the transient neurological disease.

Omphalocele in a newborn baby exposed to sodium valproate in utero.

We report on a newborn baby, exposed to valproic acid in utero, with the typical dysmorphic features of the fetal valproate syndrome and omphalocele. One identical case has already been reported after valproic acid exposure in utero.

[Intraosseous vascular access, a technic previously underestimated in France]. / La voie intraosseuse, une voie d'abord vasculaire méconnue en France.

Intraosseous vascular access is a simple and very efficient technique for fluid and drug administration in any pediatric emergencies where the intravenous route is impossible or inadequate. Yet it remains unrecognized in France. Its pharmacokinetics is close to that of peripheral intravenous route, but it allows much greater infusion flow rates. In pediatric resuscitation it must be considered as the number one technique of intravascular access in infants, and rapidly as the first alternative after failure of attempt of intravenous route in children under 6. Provided that the technique is performed with careful asepsis, the risk of infectious complications is very low. However the intraosseous route must remain a transitory vascular access, and has to be stopped as soon as possible, its use never exceeding 24 hours.