[Organization of patient management in level II centers in the Paris area: a prospective survey]. / Organisation de la prise en charge dans les centres de niveau II en région parisienne: enquête prospective.

Perinatal asphyxia is a common emergency for both obstetricians and pediatricians. A prospective study was conducted in 14 maternity hospitals (type II centres) in the Paris suburbs in order to assess pediatric activity and neonatal morbidity associated with supposed perinatal asphyxia in term newborns. Pediatricians were called in at birth very frequently: 1/20 deliveries. Intubation and/or resuscitation procedures were needed in 20% of cases and 20% of infants were referred to a neonatal unit for birth asphyxia or associated pathology. Moderate encephalopathy was observed in 1.5% of all term newborns who needed medical intervention for supposed birth asphyxia.

Human immunodeficiency virus-1 infection in neonates: correlation of plasma and cellular viremia and clinical outcome. French Pediatric Cohort Study Group.

Among human immunodeficiency virus-1 (HIV-1) vertically infected children, two patterns of disease progression have been observed: about 25% develop a severe immunodeficiency within the first 2 years of life; the rest experience a slower progression, like adults. We have assessed infectious viral burden in infected neonates through the French National Prospective Study. Plasma and cell-associated viremia were assayed by endpoint-dilution cultures in samples from 46 infants followed prospectively from birth. Plasma and cell-associated viral burden were found to be significantly higher in rapid progressing infants than in non-progressing infants in the first months of life: before the age of 2 months, between 2 and 4 months of age and by the age of 6 months. Moreover, among the non-progressing children, the infectious viral burden before the age of 4 months was predictive of the viral burden measured after the age of 12 months. In conclusion, this work demonstrates that infectious viral load is a reliable predictive marker for rapid progression to AIDS in infants and could be useful for initiating antiretroviral therapy.

[Value of fast indirect immunofluorescence diagnosis of respiratory viruses]. / Intérêt de la détection rapide par immunofluorescence indirecte des virus à tropisme respiratoire.

Four hundred and three nasopharyngeal aspirates from hospitalized children have been analysed for RSV, influenza A and B, parainfluenza 3, adenovirus, with Monofluor Kits Diagnostics Pasteur. One hundred and seventeen positive samples were found, RSV: 69, influenza A: 17, influenza B: 12, parainfluenza 3: 2 and adenovirus: 17. Rapid diagnosis of viral diseases allows to decrease the incidence of nosocomial infections, to watch over infants carrying RSV who might develop severe bronchiolitis. This technique combined with anatomic examination showed that sudden death occurred, in 7 of 15 infants, during an acute respiratory infection (RSV: 6).

[Pleuropulmonary colibacillus infection in a 9-year-old boy leading to the diagnosis of Bruton agammaglobulinemia]. / Infection pleuro-pulmonaire à colibacille chez un garçon de neuf ans, conduisant au diagnostic d'agammaglobulinémie de Bruton.

A nine-year-old boy was hospitalized for pneumonia of the left lower lobe. A left pleural effusion developed 48 hours later. The same E. coli strain was recovered from five blood cultures, pleural fluid, and middle ear fluid. Recovery was achieved after two months. Pleural lavage was performed twice daily for the first 15 days and parenteral antimicrobial therapy was given for 45 days. Because E. coli is not usually responsible for ENT or lower respiratory tract infections, an immune deficiency was sought for. The index patient had a twin in whom a history of osteomyelitis at the age of 2 and pneumonia at the age of 8 was found. Recurrent otitis had been a problem in both twins from the age of 14 months. In both twins, immunoglobulin assays led to the diagnosis of Bruton agammaglobulinemia. These two children are now receiving intravenous infusions of human immunoglobulins every three weeks. Bruton agammaglobulinemia is infrequently diagnosed at so late an age.

[Post-convulsion cerebral atrophy in children: tomodensitometric evidence of cerebral lesions (author's transl)]. / Atrophie cérébrale post-convulsive de l'enfant. Objectivation tomodensitométrique des lésions cérébrales du syndrome hémiconvulsion, hémiplégie, épilepsie.

An 18 month old child who presented with convulsions and hemiplegia is described. The value of cerebral tomodensitometric for the detection of cerebral lesions is emphasised.