[Linear hyperpigmentation in the newborn]. / Pigmentation linéaire du nouveau-né.

UNLABELLED: Linear hyperpigmentation following the cutaneous bending lines of the fetal position is rarely reported. CASE REPORT: A Senegalese, black, male newborn had presented a pigmentary abnormality since birth. He was born at term and examination revealed extensive linear and retiform pigmentation of the extremities. The hyperpigmentation disappeared completely by two to three months of age. There was a family history in Senegal. COMMENTS: Our case resembles others found in the literature. A defect of migration of the melanocytes and an ethnic factor may be hypothesized.

[Brief antiseptic application of iodine in neonatal intensive care units: effects on thyroid function]. / Application brève d'antiseptique iodé en soins intensifs néonatals: conséquences sur la fonction thyroïdienne.

BACKGROUND: Transient thyroid dysfunction with its adverse effects of diminished levels of thyroid hormone on mental development has been reported in neonates whose skin has been cleaned with iodine-containing substances. We report the results of thyroid screening in iodine-exposed neonates and controls. POPULATION AND METHODS: Thirty seven neonates admitted to an intensive care unit from 1990 to 1992 and whose medical condition required umbilical catheterization were included in the study. There were 21 neonates (six term and 15 preterm) for whom the area around the umbilicus was cleansed with iodine antiseptic and 16 controls (four term and 12 preterm) for whom the antiseptic used did not contain iodine. Levels of serum free T3 and T4, and TSH were determined by 7 days after catheterization as did urinary iodine and creatinine concentrations. RESULTS: Iodine-exposed neonates had significant high levels of TSH (P < 0.01) and low free T3 (P < 0.05); levels of free T4 were lower than in controls but not significantly. Urinary iodine excretion was significantly increased. The increase in TSH disappeared between 15 and 30 days after iodine application. CONCLUSION: Application of iodine antiseptics may cause transient thyroid dysfunction in neonates leading to propose the use of non iodinated substances with similar antibacterial efficacy.

Carnitine-acylcarnitine translocase deficiency with severe hypoglycemia and auriculo ventricular block. Translocase assay in permeabilized fibroblasts.

Deficiency of the enzymes of mitochondrial fatty acid oxidation and related carnitine dependent steps have been shown to be one of the causes of the fasting-induced hypoketotic hypoglycemia. We describe here carnitine-acylcarnitine translocase deficiency in a neonate who died eight days after birth. The proband showed severe fasting-induced hypoketotic hypoglycemia, high plasma creatine kinase, heartbeat disorder, hypothermia, and hyperammonemia. The plasma-free carnitine on day three was only 3 microM, and 92% of the total carnitine (37 microM) was present as acylcarnitine. Treatments with intravenous glucose, carnitine, and medium-chain triglycerides had been tried without improvements. Measurements in fibroblasts confirmed deficient oxidation of palmitate and showed normal activities of the carnitine palmitoyltransferases I and II and of the three acyl-CoA dehydrogenases. A total deficiency of the carnitine-acyl-carnitine translocase was found in fibroblasts using the carnitine acetylation assay (1986. Biochem. J. 236:143-148). This assay has been further simplified by seeking conditions permitting application to permeabilized fibroblasts and lymphocytes.

In utero treatment of toxoplasmic fetopathy with the combination pyrimethamine-sulfadiazine.

The mothers of 52 fetuses with toxoplasma fetopathy diagnosed in utero were treated with a combination pyrimethamine-sulfa drug and spiramycine. Their infants were compared to a group of 51 infants whose mothers had received spiramycine alone. Postnatal treatment was identical in both groups. Parasitological investigation of the placenta was positive in 42 and 76.6%; the newborns had a specific IgM of 17.4 and 69% in groups 1 and 2, respectively. These differences were significant. The mean specific IgG titer was significantly reduced at birth and at 4-6 months of age in group 1. According to the results obtained in the present material the pyrimethamine-sufa drug combination, given to the mothers of fetuses infected with toxoplasma, has a significant effect on the parasitological and serological signs of evolutive fetopathy. It did not significantly alter the clinical pattern, probably because the onset of treatment was too long after maternal infection.

[Fetal toxoplasmosis. In utero treatment with pyrimethamine sulfamides]. / Foetopathie toxoplasmique. Traitement in utero par l'association pyriméthamine-sulfamides.

The mothers of 52 cases of toxoplasmic fetopathy diagnosed in utero by fetal blood and/or amniotic fluid sampling were treated with the combination pyrimethamine-sulfadiazine (or sulfisoxazole) and by spiramycine. The infants were compared with 51 other infants with congenital toxoplasmosis whose mothers had received spiramycine alone. Patients of both groups received the same pyrimethamine-sulfadiazine and spiramycine treatment after birth. Parasitologic examination of the placenta was positive in 42 and 76.6% of patients, in group I and group II respectively. The newborns had specific IgM in 17.4 and 69.2% of cases respectively in both groups. These differences were significant. The mean specific IgG titer was significantly reduced at birth and 4 to 6 months of age in the first group. Patients in group I had more often subclinical infection than patients of the comparison group: 57% vs 33.3%. They had less often a high cerebro-spinal protein content during the first week. Prenatal treatment with pyrimethamine-sulfadrugs resulted in a less progressing infection at birth. However in cases with clinically patent toxoplasmosis, the frequency of overt localizations and their sequellae was not significantly altered. This might be related to a relatively late onset of the treatment. The pyrimethamine-sulfadrug combination given to mothers of proved infected fetuses can be rewarding. The indication might be extended to well-documented seroconverted mothers if, in the future, the acquired experience and necessary pharmacological studies bring the proof of its innocuousness.

[Neonatal septicemias: biological diagnosis and antibiotherapy. Apropos of a series of 46 cases]. / Septicémies néonatales: diagnostic biologique et antibiothérapie. A propos d'une série de 46 cas.

The records of 46 neonates with proven septicaemia were retrospectively studied. Patients could be divided in 2 groups: in group 1 (21 infants) a positive blood culture was obtained before one day of life; in group 2 (25 infants) a positive blood culture was obtained between days 1 and 28. The sensitivity of 9 chemical and bacteriological tests and the efficacy of the initial antibiotic treatment were examined in both groups. Of the 21 germs isolated in patients from group 1, 86% were Gram positive bacteria and 95% were susceptible to ampicillin. Of the 26 germs isolated in patients from group 2, 80% were Gram negative enteric bacteria and 86% were susceptible to cefotaxime. Bacterial tests (gastric aspiration, antigen detection, feces culture) had a better sensibility than biochemical tests (C reactive protein, orosomucoid, fibrinogen).

[6 cases of toxoplasmosis in twins]. / A propos de six observations de toxoplasmose gémellaire.

Studies of congenital toxoplasmosis in twins confirm the definite role of the placenta in the modalities and mechanism of fetal contamination. In single-chorion twin pregnancies, clinical manifestations are generally identical in both infants. Conversely, twins from double-chorion pregnancies usually have different clinical patterns; occasionally, only one of the twins is affected (1 case). The diagnosis can be ascertained antenatally by sampling blood from each of the fetuses (2 cases). The cases reported herein illustrate some of the diagnostic pitfalls that may lead to inappropriate discontinuation of monitoring and treatment: negative placental studies, absence of specific IgM antibodies, transient fall in IgG antibody titers, delayed fetal contamination after a negative fetal blood study, and need for routine tests for increased CSF albumin levels.

Fetal toxoplasmosis: outcome of pregnancy and infant follow-up after in utero treatment.

Eight-nine cases of fetal Toxoplasma infection are reported in women treated with spiramycin during pregnancy. Thirty-four pregnancy terminations were performed (2.7% of the total number of acquired Toxoplasma infections during pregnancy). Fifty-two pregnancies were allowed to proceed (43 being additionally treated with pyrimethamine and sulfonamides), leading to the birth of 54 live infants. After a mean follow-up period of 19 months, 41 infants had evidence of subclinical Toxoplasma infection, 12 had a benign form, and one had severe congenital toxoplasmosis (this infant did not receive the additional treatment during pregnancy). Efficacy of the additional treatment with pyrimethamine and sulfonamides was demonstrated by a significant reduction of severe congenital toxoplasmosis and the relative decrease of the ratio of benign to subclinical forms. We recommended that spiramycin treatment be started as soon as possible once the diagnosis of maternal Toxoplasma infection during pregnancy is proved or strongly suspected, because a prolonged time interval between onset of infection and start of treatment seems to be associated with the presence of severe fetal lesions at the time of prenatal diagnosis.

Physiology and management of intrauterine growth retardation: a biologic approach with fetal blood sampling.

Intrauterine growth retardation is a major contributor to perinatal mortality and morbidity. The most important obstetric problem is to determine which fetuses are well in utero and which are at risk of irreversible damage or severe and prolonged neonatal morbidity. The optimal timing of delivery is at present made by subjective assessment of clinical variables. We present hematologic and biochemical values obtained by fetal blood sampling of 24 idiopathic fetuses with intrauterine growth retardation to give objective information on which to base clinical management. The results show that there is stimulation of erythropoiesis as well as evidence of red blood cell destruction and liver damage. In many cases there is acute decompensation with acid base abnormalities in a setting of chronic hematologic and biochemical changes.

[Use of imipenem-cilastatin in neonatal septicemias caused by gram-negative bacilli multiresistant to beta-lactam antibiotics]. / Utilisation de l'imipénème-cilastatine dans les septicémies du nouveau-né à bacilles Gram négatif multirésistants aux bêtalactamines.

Seven neonates with septicemia due to Gram negative bacteria resistant to beta-lactam received imipenem-cilastatin therapy. Bacteria isolated were Enterobacter cloacae [3], Enterobacter aerogenes [1], Klebsiella pneumoniae [1], Serratia marcescens [1], Pseudomonas fluorescens [1]. The MICs of imipenem were lower 1 microgram/ml. In 3 children septicemia occurred during previous antimicrobial chemotherapy. 3 IV 60 mg/kg doses of imipenem with amikacin (15 mg kg/d) were administered every day. For five children blood cultures were negative after 48 hours of treatment. E. aerogenes septicemia required pefloxacin because blood cultures remained positive (d5) despite an increased dosage (90 mg/kg/d). All children were cured and imipenem-cilastatin was not responsible for any complication. Those results demonstrate the efficacy of imipenem in the treatment of septicemia in newborns due to multiresistant Gram negative bacteria.

Fetal curarization for prenatal magnetic resonance imaging.

Fetal magnetic resonance (MR) imaging was performed at 33 weeks of gestation for investigation of a posterior fossa abnormality found at ultrasound screening. Fetal movements were abolished by vecuronium injected under ultrasound guidance into the umbilical vein. MR images showed atrophy of the left cerebellar lobe with cisternal dilatation. These were confirmed postnatally by CT scan.

Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis.

When infection with Toxoplasma gondii occurs during pregnancy, there is a risk that the parasite will cause severe congenital toxoplasmosis. We developed a method of diagnosing and treating congenital toxoplasmosis in utero. Diagnosis was based on the identification of maternal acute infection, followed by culture of fetal blood and amniotic fluid, testing of fetal blood for toxoplasma-specific IgM and nonspecific measures of infection, and ultrasound examination of the fetal brain. Treatment included the administration of antibiotics to all mothers with confirmed acute infection during pregnancy, with more intensive antibiotic treatment of those who had infected fetuses and who chose to continue the pregnancy. We report a prospective study of 746 documented cases of maternal toxoplasma infection, in which the infants were followed for at least three months. Infection was diagnosed antenatally in 39 of 42 fetuses. Twenty-four of the 39 pregnancies were terminated, and 15 were continued. All the mothers were treated with spiramycin throughout pregnancy; if fetal infection was demonstrated, pyrimethamine and either sulfadoxine or sulfadiazine were added to the regimen. Of the 15 fetuses with congenital toxoplasmosis who were carried to term, all but 2, who had chorioretinitis, remained clinically well during follow-up. We conclude that prenatal diagnosis of congenital toxoplasmosis is practical and that prenatal therapy in women who wish to continue their pregnancies reduces the severity of the manifestations of the disease.

[Mediterranean boutonneuse fever. Apropos of a fatal case in a newborn infant]. / Fièvre boutonneuse méditerranéenne. A propos d'un cas mortel chez un nouveau-né.

The authors report the case of a 20 day-old neonate who presented with boutonneuse fever. According to their knowledge, this is the first reported case occurring in a neonate. In this child, the infection seemed to be unusually severe with rapid evolution and encephalic signs.

[Low serum thyroxin and thyroxin-binding globulin in neonatal respiratory distress (author's transl)]. / Abaissement de la thyroxine plasmatique et de sa protéine porteuse au cours des détresses respiratoires néonatales.

Measurements of thyroxin (T4), thyroxin-binding globulin (TBG) and TSH were carried out in 34 full-term newborns, 21 prematures and 11 neonates with respiratory distress (6 with hyaline membrane disease) at 5 days of age. In cases with neonatal respiratory distress and to a lesser extent in prematures, low T4 due to a decrease of TBG was found, TSH being identical in all groups. The positive correlation between TBG and transferrin suggests a disturbance in hepatic synthesis. The authors conclude that, in cases with neonatal respiratory distress, low T4 does not mean hypothyroidism and does not require a treatment, provided TSH remains within normal limits.

[Effects of cefotaxime on the intestinal bacterial ecosystem in children (author's transl)]. / Effets du céfotaxime sur l'écosystème bactérien intestinal de l'enfant.

Cefotaxime activity was studied in pediatric practice on the intestinal bacteria flora of 10 children, by means of a differential quantitative method for aerobic and anaerobic faecal flora and was compared to that of 41 controls not receiving any antibiotics. Cefotaxime was given alone in 7 children, and in combination with gentamicin in 3. An effect on the intestinal bacterial flora was noted on E. coli, which disappeared in 4 cases and diminished considerably in 5. A slight increase in Streptococcus D was observed without excessive multiplication of the flora. The study showed no significant alteration for the other aerobic or anaerobic bacilli. There was no selection of resistant organisms. Cefotaxime is a new cephalosporin which does not seem to produce an increase in many resistant pathogens due to a break-down of the barrier effect observed on the bacterial flora of the gut in children.

[Cefotaxime and Gram-negative infections in children. Effectiveness and tolerance (author's transl)]. / Le céfotaxime dans les infections à bacille à Gram négatif de l'enfant. Efficacité, tolérance.

Twenty-six children, aged from 15 days to 14 years, were treated with cefotaxime. 5 were suffering from septicaemia, 14 from respiratory tract infection and were ventilated (intensive care unit), 4 from urinary tract infection and 3 from otitis media complicated with renal failure (nephrology unit). The choice of cefotaxime treatment was based upon the bacterial activity. The daily dose was 50 to 100 mg/kg by the i.m. route, or by slow intravenous injection every 8 hours. In 17 patients, cefotaxime was combined with an aminoglycoside (gentamicin or amikacin). The results were evaluated on the basis of clinical, radiological and bacteriological criteria and, whenever possible, were correlated to the serum levels of antibiotic. The antibiotic was clinically effective in 25 out of 26 patients. The three deaths that occurred, were due to the nature of the initial disease. Tolerance was good in all the patients studied. The efficacy of cefotaxime correlated well with the favorable in vitro bacteriological results and with serum concentrations. Cefotaxime is well tolerated as shown in newborn babies. Cefotaxime is markedly different from previous cephalosporins, because of its high antibacterial activity on most Gram-negative bacilli.