Disabilities and trends over time in a French county, 1980-91.

AIM: To describe trends over time and types of disability for children born in a French county from 1980 to 1991. METHODS: Data were collected from medical records of a morbidity register; disabled children with at least one severe deficiency have been included. Prevalence rates are given per 1000 resident children, over four three-year periods. RESULTS: Overall, 7.73 per 1000 children (that is, 1360 children), had a severe childhood disability, and the prevalence rate had increased significantly since 1980. This increase was mainly owing to an increase in cerebral palsy and psychiatric disorder prevalence rates. CONCLUSION: Future research aimed to explain these trends over time can be based on such data. The present knowledge is useful for planning purposes.

[An unrecognized neonatal emergency: extensive hematoma of the scalp. 5 cases]. / Une urgence néonatale méconnue: l'hématome extensif du cuir chevelu. 5 observations.

BACKGROUND: Subgaleal hemorrhage results from a pericranial effusion of blood subsequent to neonatal trauma. This exceptional situation compared with other pericranial effusion conditions in the neonate may be life-threatening. CASE REPORTS: We report the obstetrical and neonatal data in 5 cases of subgaleal hemorrhage observed in our unit over an 8-year 8-month period. We detail one particularly demonstrative case which illustrates the potentially serious course of certain clinical presentations. DISCUSSION: Subgaleal hemorrhage is a clinical diagnosis. Signs of hemorrhagic shock are associated with hemostasis disorders in the more severe forms of the condition. The main risk factor is instrumental delivery with suction. Careful monitoring is required.

[Influence of sodium alginate on the intestinal transit in low birth weight newborn infants]. / Influence de l'alginate de sodium sur le transit intestinal du nouveau-né de petit poids de naissance.

Sodium alginate (Gaviscon) is used in the management of gastro-oesophageal reflux in infants. No digestive disadvantages have as yet been reported with the use of the Gaviscon formula available in France, which contains neither aluminium hydroxide nor thickener. Twenty-two healthy neonates were prospectively studied before and after Gaviscon treatment in order to characterize their whole gut transit time with the use of a carmine index. The head of the marker appeared within the same time in both experiments but the appearance of the tail was earlier in the treated infants (P < 0.05), without any subsequent clinical consequences. The slight increase shown in the rate of the clearance of the marker from the gut, is likely to be related to a less proximal to distal dispersion of the marker, subsequently to physical changes occurring in the viscous alginate. Frequency and consistency of the stools were unmodified by treatment and accordingly Gaviscon can be regarded as having no deleterious effect on transit time in neonates.

[Listeria monocytogenes nosocomial infection in the maternity ward]. / Infection nosocomiale à Listeria monocytogenes en maternité.

Nosocomial infection with Listeria monocytogenes 4b occurred in January 1990 in a maternity hospital in Grenoble. The 3 patients involved were born within a 24 hour-interval. The premature newborn responsible for contamination was asymptomatic. Two other newborns without any perinatal infectious risk presented with meningitis, one on the 5th day of life in the maternity hospital, the other one on the 11th day while already at home. The 3 strains of Listeria had the same serovar and lysovar. Epidemiologic investigations led to suspect a contamination in the delivery room and during the care of the children. Strict respect of hygiene orders is imperative to avoid nosocomial infections.

Prediction of outcome by prenatal Doppler analysis in a patient with aortic stenosis.

Stenosis of the aortic valve (pressure drop 50 mm Hg) was diagnosed prenatally by Doppler echocardiography in a 33 week old fetus. Measurement of time-velocity integrals through the tricuspid and mitral valves indicated a significantly higher flow in the right heart. The pressure drop across the aortic valve in the 3 hour old infant was 80 mm Hg. The findings in this patient suggest that the usually accepted theory that prenatally the ventricles function in parallel should take into account the chronology of filling and ejection. In this patient the ability of a ventricle to generate a prenatal transvalvar pressure gradient was evidence that the size, compliance, and contractility of the ventricle were sufficient to maintain good function.

[Pneumoperitoneum in a newborn infant after assisted ventilation]. / Pneumopéritoine chez le nouveau-né ventilé.

The authors report a case of massive pneumoperitoneum in a newborn who underwent assisted-ventilation for a severe aspiration of meconial amniotic fluid. Clinical and roentgengraphic findings that are helpful in differentiating a pneumoperitoneum of gastrointestinal origin from an extrathoracic air leak are reviewed. In such a situation, laparotomy should be avoided.

[Somatostatin in a case of neonatal hyperinsulinism caused by focal adenomatosis of the head of pancreas]. / La somatostatine dans un cas d'hyperinsulinisme néonatal par adénomatose focale de la tête du pancréas.

The use of somatostatin in the treatment of a newborn infant with hyperinsulinism is reported. When administered alone, somatostatin was only able to prevent hypoglycemia for a short period of time, whereas the addition of a constant infusion of glucagon allowed successful control of the patient's hypoglycemia. As hyperinsulinism relapsed after a subtotal pancreatectomy, a trial was carried out with a somatostatin analog, which has an expected longer duration of action. It led to a significant rise in the blood glucose level but failed to prevent safely hypoglycemia even when 4 injections were performed daily.

[Diagnosis of neonatal Streptococcus B infection by the latex test]. / Diagnostic de l'infection néonatale à streptocoque B par un test au latex.

The detection of group B streptococcal soluble antigens was performed in 139 newborn infants suspected of infection. A qualitative agglutination test of sensitized latex particles (Wellcogen Strep B) was performed in the urine. The diagnosis of group B streptococcal infection was assessed by retrospective analysis of patient files using previously defined criteria. The correlation between the agglutination test result and the presence or absence of streptococcal infection was statistically significant; the test had a sensitivity of 81%, specificity of 97%, positive predictive value of 76% and negative predictive value of 98%. This study confirms the interest of such a test in the early diagnosis of group B streptococcal infection in infants.

Effect of sodium benzoate on the cutaneous bilirubin content of the adult Gunn rat.

Na benzoate, which dissociates intravascular bilirubin-albumin complexes, might thus have the potential for driving bilirubin from the plasma into tissues such as the skin. We investigated this hypothesis in the adult Gunn rat. As others, we observed an early fall in blood bilirubin concentration after intraperitoneal Na benzoate injection, without any change in skin bilirubin content. Nevertheless, we observed a significant decrease (p less than 0.01) in skin bilirubin content at 24 and then 48 h after Na benzoate injection, at which times blood bilirubin remained at a low level. The phenomenon was reversible since, at 8 days after Na benzoate injection, blood and skin bilirubin contents had returned to control values. Regarding the decrease in skin bilirubin content after Na benzoate injection we described a dose-effect relationship. So, we could not confirm our hypothesis. We concluded that the phenomenon we observed is probably due to a shift in the distribution equilibrium of the pigment between serum, skin and other tissues.

A spectrophotometric assay of skin bilirubin in adult Gunn rats.

The present study was undertaken to assess the value of a spectrophotometric method for the assay of bilirubin content in Gunn rat skin. The pigment extraction was performed by incubating skin strips in a barbital-acetate buffered methanol-chloroform mixture at pH 7 for 90 min. The procedure yielded an overall recovery average of 93 +/- 9% which was not influenced when the incubation time was varied from 1 to 2.5 h. The bilirubin concentration in skin extracts was calculated from spectrophotometric absorbance readings and according to the molar extinction coefficient of the pigment in chloroform. Bilirubin appeared to remain stable during the analytical process. The mean bilirubin content as measured by this method was 1.88 mumol/100 g (1.1 mg/100 g). It is concluded that the proposed method is well suited for the investigation of bilirubin skin metabolism.

[Long-term follow-up of 128 children 13-14 years old, with birth weights of less than 2500 grams]. / Avenir lointain de 128 enfants agés de 13 à 14 ans, de poids de naissance inférieur à 2500 grammes

The records of 128 children, whose birth weight was below 2500 g and who were seen again at the ages of 13-14 years, were analyzed. Owing to the knowledge of the data of the last maternal menses in 115 cases, they could be separated in at-term dysmature, premature dysmature and true premature infants. The comparison between the 3 groups led to the following differences: On average, there is little difference between true premature infants and normal neonatal population, on both somatic and psychological points of view. Physical development is less satisfactory in at-term dysmature infants. If their median of I.Q. is close to normal, high intellectual abilities are rare and mental deficiency more frequent. In the physical, auditory, visual and psycho-motor fields, premature dysmature infants are the most underpriviliged.