Successful early surgical treatment in neonatal compartment syndrome: case report.

Neonatal compartment syndrome is rare, and the diagnosis is often missed or delayed because other ischemic diseases can mimic clinical signs observed on the skin. A premature newborn infant presented with skin lesions during the first hours of life that were recognized as the sentinel finding in compartment syndrome of the newborn. We restored normal function by emergency surgery. The authors highlight the importance of effective collaboration between pediatricians and surgeons to improve the management of this neonatal condition.

[Establishment of the intestinal microflora and regulation of bacterial translocation after caffeine citrate treatment during postnatal period in rat]. / Implantation de la microflore intestinale et régulation de la translocation bactérienne sous l'effet d'un traitement au citrate de caféine chez le raton en période néonatale.

To relieve respiratory problems such as apnea in newborns, caffeine citrate is the drug of choice because of its good tolerance and therapeutic index. However, its impact on the intestinal microbial ecosystem and on bacterial translocation in the neonatal period remains insufficiently investigated. Therefore, the objective of this study was to evaluate the effects of caffeine citrate on the establishment of the intestinal microflora and bacterial translocation in rats from birth to the 30th day of life. Newborn Wistar rats were divided into four groups of 14 animals, each subdivided into a control group receiving a placebo (12mL tap water/kg/day) and another treated with caffeine citrate (12mg/kg/day). The animals were nursed by their mothers and weighed daily. A group of 14 rats was killed at birth and after 10, 20, or 30 days of life. Organs in which translocation was assessed (liver, lungs, spleen, and kidneys) and various fragments of intestine (duodenum, jejunum, ileum, and colon) were surgically removed. The bacteriological analysis performed involved enumeration of the total microflora, staphylococci, enterobacteria, and lactobacilli. From the 10th day, caffeine was shown to significantly decrease the weight of treated animals as compared with controls (P<0.05). However, caffeine treatment did not drastically alter the kinetics of establishment of the intestinal microflora as only enterobacteria were found to be significantly lower in any intestinal segment of the treated group (P<0.05). Moreover, from the 20th day of life, caffeine citrate significantly downregulated bacterial translocation of both Gram-positive and -negative bacteria (P<0.05). This preliminary study on the effects of treatment with caffeine citrate may open opportunities in clinical pediatrics; the treatment will remain partially effective in preventing bacterial translocation in the neonatal period.

[Assessment of erythropoietin treatment in preterm newborns older than 30 weeks of gestation]. / Evaluation du traitement par érythropoïétine chez les nouveau-nés de plus 30 semaines d'aménorrhée.

BACKGROUND: Human recombinant erythropoietin (rhEPO) has shown a benefit in reducing the number of transfusions in very-low-birth-weight infants. However, no study has reported benefits in older preterms (i.e., 30-32 weeks of gestation [WG]). This study aimed to evaluate the benefit of rhEPO between 30 and 32 WG. METHODS: Two groups of preterms between 30 and 32 WG were compared in a retrospective study: period 1 with rhEPO (January 2005 to October 2006) and period 2 without rhEPO (November 2006 to May 2007). Newborns with intra-uterine growth retardation, rhesus isoimmunization or surgical procedures were excluded. The main criterion was the number of blood transfusions; the second criterion was hemoglobin at 2, 4 and 6 weeks of life. Morbidity was evaluated on necrotizing enterocolitis, intraventricular hemorrhage (IVH) and periventricular leukomalacia. RESULTS: Fifty-nine newborns receiving rhEPO and 19 not receiving rhEPO (controls) were included. The two groups were similar for birth weight (p=0.06) and hemoglobin at birth (p=0.41). Only one child (rhEPO group) needed a transfusion. Hemoglobin at 2 weeks (p=0.74), 4 weeks (p=0.13) and 6 weeks (p=0.35) were not statistically different. There was no difference between the 2 groups for necrotizing enterocolitis, IVH or periventricular leukomalacia. CONCLUSION: This study did not find any benefit using rhEPO in 30 to 32 WG preterm infants in terms of the number of transfusions or hemoglobin levels.

Persistent pulmonary hypertension of the newborn with transposition of the great arteries: successful treatment with bosentan.

Persistent pulmonary hypertension of the newborn (PPHN) occurs in 1-4% of neonates with transposition of the great arteries with intact ventricular septum (TGA/IVS). This association is often lethal. To our knowledge, only eight survivors have been described in the literature, two of whom benefited from extracorporeal membrane oxygenation (ECMO). We report two cases of PPHN complicating a TGA/IVS that were refractory to multiple therapies and resolved 48 hours after initiation of bosentan therapy. Bosentan, an oral dual endothelin-1 receptor antagonist, is a new treatment for pulmonary arterial hypertension that was both effective and safe in these two cases of TGA/IVS with PPHN. To our knowledge, it is the first use of bosentan in newborns.

[Neonatal renal venous thrombosis following an electrical shock in pregnancy]. / Thrombose néonatale de la veine rénale suite à une électrisation in-utero accidentelle.

Neonatal renal venous thrombosis may result in severe morbidity. Predisposing conditions are well known. We report the case of an unusual and early neonatal renal venous thrombosis. The mother received an electrical shock at 34 weeks gestation. This case demonstrates that maternal electrical shock effect on the fetus should be early investigated.

[Case control study of extended-spectrum betalactamase producing Serratia marcescens outbreak in a paediatric intensive care unit]. / Etude cas-témoins d'une épidémie à Serratia marcescens dans un service de réanimation pédiatrique.

OBJECTIVES: To identify patient-related risk factors of infection and ways of transmission of extended-spectrum betalactamase (ESBL) producing Serratia marcescens in the paediatric intensive care unit (PICU) of Amiens university hospital (France) between June and July 2002. METHODS: Five cases (four pulmonary infected and one stool contaminated symptom-free neonates) and 35 controls, admitted in the PICU, are included. S. marcescens ESBL analysed are isolated from respiratory tract and faecal samples for cases and urine and pus samples from two non-paediatric other patients. Univariate and multivariate analysis are performed on EPI INFO 6.04 dFr and SPSS 11.0.1. RESULTS: S. marcescens ESBL infections or colonisations rate is 12.5% [4.7-27.6]. The incidence is 8.8 [6.7-11.6] per 1000 hospital-stay days. By univariate analysis, cases and controls don't differ with respect of age, sex, and weight at admission or preterm delivery. Cases don't have more often invasive nursing care than controls. But, they were intubated (P <0.03) and hospitalised (P <0.03) for a longer time than controls. Linear regression analysis showed that duration of intubation was independent predictor of acquisition of S. marcescens ESBL (P <0.008). S. marcescens ESBL strains implicated in pulmonary infections, showed the same pattern of multidrug resistant and ERIC-PCR profile. This clone differs from others isolated from stool or other samples from other hospital wards. CONCLUSION: As S. marcescens cross-colonization appears to be due to lake of hand hygiene and asepsis during invasive nursing care, reinforcing hygiene measures permit to contain the outbreak.

Measurement of functional residual capacity through the transient phase of He dilution in newborns.

Helium dilution maneuver is used to determine the functional residual capacity (FRC) 14 newborns ages 1-5 mo. The model equation describes the changing alveolar fractions of He and the ventilation promoted by a rebreathing procedure that does not exceed 40 s. The model does not involve the volume of the rebreathing bag usually needed when applying rebreathing technique and which is a source of error. The equation is discretized and solved for recorded data obtained with equipment adapted to newborns. Results show a strong relationship between FRC and the biometrical indexes, and confirm those found in the literature featuring that the measurement duration of FRC can be considerably shortened.

[Neonatal deafness screening with the evoked otoacoustic emissions technique. Study of 320 newborns at the neonatal resuscitation service of the Amiens neonatal care unit]. / Dépistage de la surdité néonatale par la technique des otoémissions acoustiques provoquées. Etude à propos de 320 nouveau-nés du service de réanimation néonatale du CHU d'Amiens.

Between January 1997 and June 1999, we screened for hearing loss using evoked otoacoustic emissions in 320 newborns in the neonate intensive care unit at the Amiens University Hospital. The purpose of this study was to search for correlations between deafness and one of the hearing loss risk factors identified by the Joint Committee on Infant Screening. Three risk factors were found to be significant: craniofacial abnormalities, low birth weight (less than 1500 g) and a familial history of hearing loss. Unfortunately a large proportion of the infants were lost to follow-up. Evoked otoacoustic emission provide an excellent screening technique for hearing loss in newborns. Such screening implies however the creation of networks to assure patient follow-up.

Determination of diffusing capacity by modeling the dynamics of C18O uptake in newborns.

Dynamic modeling of lung C18O diffusion is used to measure the C18O transfer factor (TLCO) of 14 newborns aged 1-4 mo. The model equation is based on the alveolar fractions of C18O and on changing alveolar ventilation induced by the rebreathing conditions. The model does not involve the volume of the rebreathing bag which is usually needed when applying rebreathing technique and which is a source of error. The equation is discretized and solved for recorded data obtained with equipment adapted to use in newborns. A least-square parameter calculation technique is applied to estimate TLCO. Results show a strong relationship between this index and the biometrical ones and confirm those found in the literature featuring that the measurement duration can be considerably shortened.

Reproducibility of the alternating breath test of fractional inspired O2 in infants.

We conducted a reproducibility study of the alternating breath test (ABT) for assessing peripheral chemoreceptor function in infants. The ABT delivers a rapid hypoxic stimulus to the peripheral chemoreceptors with breath-by-breath alternations of the inspired O2 fraction. The reproducibility of the ABT performed on a single occasion has not been extensively studied in infants. Eight unsedated infants (postnatal age, 22+/-19 d; weight, 3.2+/-0.4 kg) were studied in standardized conditions: morning naps, supine position, room temperature 22-24 degrees C, quiet sleep, and face mask attached to a pneumotachograph connected to a two-way electric valve. Respiratory gases were analyzed by mass spectrometer. Two ABTs were performed. Each included a 2-min control run (CR) alternating between air and air, and a 2-min test run (TR) alternating between air and 0.15 O2. After data preprocessing, on average 13+/-11% of the data were rejected because of sighs, apneas, and cycles with the fraction of inspired oxygen above 0.17. Using the remaining validated breaths, the response to ABT was calculated for the CR, for all breaths in the TR (TR(T)), and for the first 50 breaths of the TR (TR50). During the ABTs oxygen saturation did not fall below 96%, and heart rate was not affected. Inspired and end-tidal CO2 fractions remained unchanged during the ABTs. FetO2 oscillated in TRs at a lower values than in CRs and differed significantly between breaths of air and hypoxic breaths of TRs. All infants responded to ABT with percentage alternation coefficients of TRs significantly greater than those of CRs for all respiratory variables. The values of the coefficients were not significantly different between both ABT, and between TR50 and TR(T). The greatest values of the coefficients were for timing variables compared with flows and volume. We conclude that the ABT is a reproducible test of peripheral chemoreceptor function under standardized conditions.

Consequences of a small decrease of air temperature from thermal equilibrium on thermoregulation in sleeping neonates.

A new heating unit (servocontrolled skin temperature derivative system) has been designed to control the thermal environment in closed incubators. This type of control acts to attain and closely maintain a thermal equilibrium between a neonate's skin temperature and the environment. The present study aims to discover if thermal equilibrium is located within a thermoneutral range defined from oxygen consumption VO2 and body temperature, and whether it is more appropriate to define an optimal thermal environment. As regards VO2 and body temperature, results show that the air temperature reached at thermal equilibrium fulfils the definition of thermoneutrality. According to these criteria, a small decrease (1:5 degrees C) from thermal equilibrium also provides a near thermoneutral environment to the neonate but induces sleep disturbances and an increase in body movements. These two additional parameters delineate a narrower thermoneutral zone than does minimal metabolic rate because VO2 can stay constant even when air and body temperatures decrease. The results suggest that thermal equilibrium might be assimilated with a thermal comfort zone.

Skin derivative control of thermal environment in a closed incubator.

Defining a thermoneutral environment remains difficult because thermoneutrality depends on both physical and physiological factors. A servocontrolled skin temperature derivative (SCS) heating device has been designed to control the thermal environment in closed incubators without the necessity of setting an air or skin reference temperature. The thermal environment obtained with the SCS program is controlled only by the neonate's skin temperature changes. For each neonate, the program allows the attainment of a specific individual thermal equilibrium (Teq). Although the mean value of the thermal equilibrium level measured on 29 neonates does not differ significantly from the neutral air temperature defined from the charts of other researchers, individual values of Teq differed greatly among neonates of similar birthweight and postnatal age. When compared with on/off heating programs, the SCS system permits greater quiet sleep occurrence and seems to provide an optimal thermal environment. The results suggest that the skin temperature derivative heating program takes into account both the ambient and physiological factors affecting body temperature regulation of each neonate.

[Evolution of the result of respiratory function studies in children with bronchopulmonary dysplasia]. / Evolution du résultat des explorations fonctionnelles respiratoires chez les enfants atteints de dysplasie bronchopulmonaire.

BACKGROUND: Reports of short- and medium-term evolution of Lung Function Tests (LFT) in infants with bronchopulmonary dysplasia (BPD) are still scarce. POPULATION AND METHODS: The results of the first (before 3 months of corrected age) and the second (between 3 and 9 months of corrected age) LFT in 22 premature infants with BPD (gestational age 31 +/- 2.5 weeks; birth weight: 1570 +/- 440 g; duration of mechanical ventilation: 46 +/- 24 days, total duration of oxygen therapy: 88 +/- 47 days) were compared to those obtained in 27 normal infants for the first LEF and 10 normal infants for the second LFT, similar to the patients for birth weight and corporeal index (CI). RESULTS: In the first LFT, major abnormalities were an increased thoracic gaz volume (TGV) (16.5 +/- 42 vs 122 +/- 24 mL; P < 0.001) and TGV CI ratio (1.25 +/- 0.31 vs 0.89 +/- 0.17 ml/kg/m2; P < 0.0001) a decreased pulmonary compliance (2.49 +/- 1.46 vs 11.60 +/- 4.50 mL/cmH2O; P < 0.0001) and specific pulmonary compliance (0.015 +/- 0.10 vs 0.100 +/- 0.042 mL/cmH2O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (20.4 +/- 12.1 vs 10.5 +/- 5.3 cmH2O/L/s; P < 0.001). In the second LFT, an increased TGV (235 +/- 62 vs 166 +/- 28 mL; P < 0.01) and TGV CI ratio (1.64 +/- 0.65 vs 0.98 +/- 0.11 ml/kg/m2; P < 0.05), a decreased pulmonary compliance (2.68 +/- 2.0 vs 15.2 +/- 5.7 mL/cmH2O; P < 0.0001) and specific pulmonary compliance (0.013 +/- 0.010 vs 0.106 +/- 0.050 mL/cmH2O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (17.1 +/- 9.6 vs 8.6 +/- 4.9 cmH2O/L/s; P < 0.05) were noted when compared with the control group results. Major abnormalities of the blood gases were hypoxemia (63 +/- 10 vs 85 +/- 20 mmHg; P < 0.05), hypercapnia (38.5 vs 31 +/- 4 mmHg; P < 0.0001) during the first LFT. Hypoxemia (77 +/- 14 vs 90 +/- 14 mmHg and hypercapnia (37 +/- 4 vs 29 +/- 5 mmHg) continued in the second LFT. Thoracic distention and total pulmonary resistances in infants with BPD did not improve but their pulmonary compliance (P < 0.0001) and PaO2 (P < 0.01) between the first and second LFT did it. Infants who had been ventilated for a hyaline membrane disease (HMD) were more hypoxic on the second LFT (P < 0.05) than those who had been ventilated for other causes. Statistically significant relationships were found between thoracic distention and duration of positive inspiratory pressure (P < 0.05; r = 0.43), duration of positive expiratory pressure (P < 0.05, r = 0.45) total oxygen therapy duration; between total pulmonary resistance and duration of mechanical ventilation with high frequency (P < 0.05; r = 0.52); between hypoxemia and duration of oxygen therapy with FiO2 > or = 60% (P < 0.05; r = 0.54). CONCLUSIONS: This study shows prolonged clinical and functional abnormalities of the respiratory functions requiring longer follow-up.

Body temperature regulation in the newborn infant: interaction with sleep and clinical implications.

Thermoregulation in newborn infant differs from that of adult. Comparisons between sleep stages show that, during rapid eye movements (REM) sleep, the impairment of thermoregulatory responses in adult is not observed in newborn. Both behavioral and autonomic temperature regulations are always operative in the range of air temperatures usually imposed. The interaction between sleep and thermoregulation seems to be less important in newborns than in adults, suggesting that sleep processes are well protected, reducing the probability of occurrence of central dysfunction. According to the model describing thermoregulation during sleep on the basis of changes in the hierarchical dominance of brain structures, either the influence of diencephalic structures is never depressed in REM sleep or the functional autonomy of the rhombencephalon is still relevant in the immature encephalon of the newborn. The thermoregulatory model also allows understanding of inter-individual differences in thermoregulation and levels of thermoneutrality. An attempt has also been made to learn the role of heat stroke in the production of sudden infant death syndrome when body heat loss is hampered.