[Newborn infants' first outpatient visit]. / Première consultation ambulatoire du nouveau-né.

The focus on outpatient follow-up of newborn infants increases as the duration of hospital stay after birth decreases. The first outpatient visit addresses the adequacy of the home transition. Appropriate feedings are checked. Sudden infant death syndrome prevention and security advices are reminded. Realisation of both neonatal dried blood screen and hearing test is confirmed, as well as planning of specific follow-up appointments. The physical exam will focus on red flags for diseases or malformations with a delayed presentation.

Le suivi ambulatoire du nouveau-né devient important en raison de la réduction progressive des séjours en maternité. Lors de cette première consultation, il convient de s'assurer du bon déroulement du retour à domicile. L'alimentation est vérifiée. Les conseils de sécurité et ceux de prévention de la mort subite du nourrisson sont rappelés. La réalisation des dépistages sanguin et auditif est contrôlée, de même que la programmation des suivis spécifiques potentiellement nécessaires. L'examen clinique recherchera les signes d'alerte des pathologies d'apparition secondaire, comme l'ictère, ou les malformations congénitales à expression tardive.

[EARLY ENTEROVIRUS NEONATAL INFECTION: WHEN SHOULD WE THINK ABOUT IT?]. / INFECTION NÉONATALE PRÉCOCE À ENTÉROVIRUS : QUAND FAUT-IL Y PENSER? Cas cliniques et revue de la literature.

Enterovirus (EV) may cause a broad spectrum of clinical syndromes and even cause a sepsis-like picture. Although they are responsible for high morbidity and mortality rates, viral testing does not appear in the algorithms for the evaluation of neonatal infections. During the month of June 2013, we identified 3 cases of EV meningitis in our unit of neonatology. All three infants had fever during the first week of life and their clinical examination revealed an irritability. The EV infection was detected by Real-Time Polymerase Chain Reaction (RT-PCR) EV on the cerebrospinal fluid (CSF). Two of the patients also had a positive RT-PCR EV in the blood. The 3 newborns were discharged from the hospital after a few days with no adverse outcome. Our clinical observations and the literature review suggest that EV infections in neonates ought to be identified as soon as possible by an early RT-PCR EV on the blood, and on the CSF if a lumbar puncture is indicated. This could help reduce the administration of antibiotics and the length of hospital stay.

[How I explore and treat a neonatal renal vein thrombosis: a case report]. / Comment j'explore et traite une thrombose veineuse renale néonatale: àpropos d'un cas.

Neonatal renal vein thrombosis is a rare condition. The present case is rather unfrequent and particularly educative since it shows the complete diagnostic triad including hematuria, flank mass and thrombocytopenia. The diagnosis relies on the demonstration, by Doppler ultrasound, of an obstructed renal venous bed. The investigation is completed by a platelet count and the determination of the prothrombin time, of the activated partial thromboplastin time as well as of the concentration of fibrinogen. The screening also includes the search for a possible etiology, such as a deficiency in coagulation proteins, the presence of antiphospholipid antibodies or of a genetic mutation of one of the coagulation factors. Since there exist no evidence based guidelines for the management of the disease, we will discuss the diagnosis and treatment in relation with the published literature.

[HIV testing among women in delivery rooms in Lubumbashi, Democratic Republic of the Congo: a catch-up strategy for prevention of mother-to-child transmission]. / Dépistage du VIH en salle de travail à Lubumbashi, République Démocratique du Congo. Une stratégie de rattrapage dans le cadre de la prévention de la transmission de la mère à l'enfant.

BACKGROUND: Although HIV testing is offered during antenatal care, the proportion of women giving birth without knowing their HIV status is still important in DR Congo. The objective of this study was to determine the acceptability of rapid HIV testing among parturients in labor room, and to identify factors that are associated with the acceptability of HIV testing. METHODS: Intervention including rapid HIV testing among pregnant women in labor rooms in Lubumbashi for 5 months, from September 2010 to February 2011. Pregnant women who tested HIV positive were attended by prevention of mother-to-child transmission service. Descriptive statistical analysis and logistic regression were performed. RESULTS: Among 474 pregnant women who enter the labor room, 433 (91.4%; confidence interval [CI]: 95%: 88.4-93.7%) had voluntary testing for HIV in the labor room after counseling. The acceptance of rapid testing for HIV was significantly higher when the duration of counseling was less or equal to 5 minutes (adjusted Odds ratio [aOR]=5.8; [CI] 95%: 2.6-13); among those who did not report having this screening test during antenatal care (aOR=3.8; [CI] 95%: 2-7.8), among those who were in early labor (aOR=2.3; [CI] 95%: 1.2-4.7) and lower in adolescents than in adults (aOR=0.1; [CI] 95%: 0.0-0.7). CONCLUSION: Counseling and voluntary HIV testing are accepted in our labor rooms. Consistently offering this service in the labor room could be a catch-up strategy to be combined with antenatal care testing.

Etude des facteurs de risque associes a l'apparition des fibromyomes uterins a Lubumbashi; Congo

1)Identifier les facteurs associes a l'apparition des fibromyomes uterins a Lubumbashi 2) Identifier les facteurs associes a l'apparition des fibromyomes uterins a Lubumbashi avant 30ans Materiel et methode :Une etude cas

Etude de la mortalite maternelle et des facteurs associes a l'hopital Jason Sendwe a Lubumbashi; Congo: de 2000 a 2010

L'hopital SENDWE est le deuxieme hopital de la Republique Democratique du Congo sur le plan capacite et est typique des pays pauvres. Cette etude a pour objectif de determiner le taux de mortalite maternelle ainsi que les facteurs associes a cette mortalite maternelle dans cette formation medicale.Methodes Cette etude; de type descriptif comparatif; s'etale sur 12 ans et couvre la periode qui va de janvier 2000 a decembre 2011. Pour analyser les donnees; nous avons utilise les mesures de tendance centrale et de dispersion; le calcul d'Odds ratio et d'intervalles de confiance. Les donnees ont ete encodees; traitees et analysees a l'aide des logiciels Excel 2007 et Epi info version 3.04.Resultats Le taux de mortalite maternelle fluctue en fonction des gestionnaires de l'hopital et de l'organisation de la maternite; nous avons les extremes de deces maternels de 314 pour 100.000 N.V. en 2002 et 870 pour 100.000 N.V. en 2011. Les etiologies les plus frequentes sont les hemorragies genitales avec 44;2. Les gestantes de 18 ans et moins courent pres de deux fois plus de risque que leurs homologues plus agees (OR=1;81 IC95 :1;38-2;38); celles de plus de 35 ans courent pres de quatre fois plus de risque que les moins de 35 ans (OR=3;93 IC 95 : 3;04-5;08). Les primipares presentent pres de deux fois plus de risque que les autres (OR=1;68 IC 95 : 1;32-2;14) et les grandes multipares ont douze fois plus de risque que les autres (OR=12;12 IC 95 : 9;64-15;24). Les gestantes et l'etat congolais ont une plus grande part de responsabilite dans la survenue des deces maternels.Conclusion Avec la disponibilisation d'un personnel qualifie; des trousses operatoires et des produits pharmaceutiques d'urgence ainsi que de poches de sang; la plupart des deces maternels sont evitables

Acceptabilité du dépistage volontaire du VIH chez les femmes enceintes à l'hôpital général de référence de Kenya à Lubumbashi en République Démocratique du Congo

Contexte. La majorité des enfants contaminés par le VIH se retrouve dans les pays en développement. En RD Congo, le nombre de nouveaux cas de VIH pédiatriques est de l'ordre de 28461 par an. L'objectif de cette étude était de déterminer l'acceptabilité du dépistage volontaire du VIH et l'adhérence à la prise en charge chez les femmes enceintes au service de prévention de la transmission du VIH de la mère à l'enfant de l'Hôpital Général de Référence (HGR) Kenya. Méthodologie. Une analyse opérationnelle des étapes du dépistage du VIH a été préalablement effectuée selon le modèle de Piot, chez 4895 femmes enceintes reçues aux Consultations Prénatales en 2007. Une enquête transversale a ensuite était conduite, sur un échantillon de convenance de 490 gestantes, pour rechercher les facteurs associés à l'acceptabilité du dépistage du VIH dans ce milieu. Les analyses statistiques descriptives et une régression logistique ont été appliquées pour l'analyse de données. Le ratio de couverture de la Névirapine a été calculé. Résultats. De toutes les gestantes admises aux CPN, 50,8% ont accepté le counselling pré-test, et 80% d'entre elles l'ont réellement effectué. De ce dernier groupe, seules 83% ont retiré le résultat du test. L'acceptabilité du test était significativement plus élevée parmi les gestantes de bas niveau d'étude (odds ratio ajusté ORa = 6,8 ; IC95% :3,5-13,35) et parmi celles qui arrivaient pour la première fois à la CPN (ORa=2, 3 ; IC : 1,2-4,4). L'adhérence à la prise en charge était de 22,4% des couples mère-enfants. Le ratio de couverture en Névirapine était de 11,4%. Conclusion. L'acceptabilité globale du dépistage du VIH et l'adhérence à la prise en charge sont relativement faibles à l'HGR Kenya. Pour améliorer le rendement de ce service, il faudrait sensibiliser les femmes et assurer le suivi des activités du service

Sterilite du couple a l'Institut Medical Chretien du Kasai

Introduction : Une etude transversale a ete menee de janvier 2004 a decembre 2007 a l'Institut Medical Chretien du Kasai. Objectifs : Definir le profil socioepidemiologique de la femme ayant consulte a l'Institut Medical Chretien du Kasai pour sterilite et determiner a partir des examens paracliniques simples la responsabilite de chaque conjoint et la cause de la sterilite. Resultats : 11des femmes ont consulte pour une notion de sterilite de minimum 2 ans. La moitie des sujets (50;8) est agee de moins de 35 ans; avec une moyenne d'age de 28 +/-3 ans. La sterilite feminine secondaire etait predominante (70;2) et la responsabilite mutuelle de l'homme et de la femme dans la sterilite a ete retrouvee dans 33des cas. Considere individuellement; l'homme est apparu avoir plus de responsabilite que la femme (34;6vs 21;4). Les femmes provenant du milieu urbain etaient majoritaires (62;1). Un niveau d'instruction ne depassant pas le cap de l'ecole secondaire apparaissait aussi comme un facteur frequemment associe a la sterilite (89.6). Les causes mecaniques ont ete plus frequentes que les causes fonctionnelles (81;2vs 18;8). L'oligo-asthenospermie a ete la cause gonadique masculine la plus importante dans notre serie (56;2). Conclusion : La sterilite du couple est un probleme de sante publique dans nos milieux a cause de sa frequence et de ses repercussions sociales. La prevention des infections sexuellement transmissibles pourrait concourir a contourner ce fleau

Prevalence et determinants de la malnutrition des enfants ages de moins de 5 ans dans le quartier Bongonga de Lubumbashi

Contexte : L'etat nutritionnel des enfants est un indicateur mondial de son bien-etre et indirectement celui de sa communaute. Les objectifs de ce travail consistent a evaluer l'etat nutritionnel des enfants ages de moins de cinq ans du quartier Bongonga de Lubumbashi; en RD Congo; et ses determinants. Methodes : Une enquete transversale a ete menee; dans des menages; aupres de 1963 enfants. Outre les variables anthropometriques; les conditions de vie ont egalement ete relevees. Une regression logistique a ete appliquee. Resultats : Les prevalences etaient de 33;5de retard de croissance et 3;8d'emaciation. En regression logistique; le niveau d'etude de la mere (moins de 7 ans); l'absence d'un robinet d'eau potable dans la parcelle; l'age superieur a 11 mois et la duree de sejour de l'enfant dans le quartier inferieure a 3 mois etaient significativement associes a un risque accru de retard de croissance. Le niveau bas d'etude de la mere et l'age de l'enfant (12 mois ou plus) etaient significativement associes du retard de croissance severe. Par ailleurs; l'anorexie; la diarrhee; la souffrance et l'age de l'enfant (moins de 12 mois) etaient les determinants significatifs d'une emaciation. Conclusion : Comparee a la classification de l'Organisation Mondiale de la Sante; la prevalence du retard de croissance est elevee et celle de l'emaciation basse. Afin de reduire la mortalite; la morbidite et contribuer au bien-etre de la population; il faut integrer ces facteurs dans toute intervention

Etat des reserves en fer des femmes enceintes; des femmes allaitantes et des enfants de 1 a 60 mois a Lubumbashi; RD Congo

Le present travail a pour objectif d'evaluer le statut martial des personnes a risque d'anemier a Lubumbashi. Le niveau des reserves en fer a ete determiner sur base du dosage de ferritine serique chez 53 femmes enceintes; 38 femmes allaitantes et 49 enfants de 1 a 60 mois. Cette etude montre que le statut martial est normal (ferritine entre 30-200 ng/ml) dans 23chez les femmes enceintes; 8chez les femmes allaitantes et 62chez les enfants. Dans les trois groupes; la carence martiale (ferritine 12 ng/ml) a ete observee respectivement dans 34; 58; et 20dans des cas alors que la precarence (ferritine entre 12-30ng/ml) ) a ete retrouve respectivement entre 43; 34; et 4des cas. Chez la femme enceinte; la grande majorite des cas de carence et de precarence a ete notee au deuxieme et au troisieme trimestre de la grossesse (62). Par ailleurs; 4d'enfants accusent une surcharge martiale (ferritine entre 500-1000 ng/ml). A la lumiere de ces resultats; une supplementation systematique en fer devra instauree chez les femmes allaittantes et les femmes enceintes au deuxieme et au troisieme trimestre de la grossesse. Chez les enfants; elle ne pourra etre indiquee que sur la base d'investigations approfondies

[Anemia prevalence in pregnant and breast-feeding women in Lubumbashi (Democratic Republic of the Congo). Impact of malaria and intestinal helminthiasis]. / Etude de l'anémie chez les femmes enceintes et les femmes allaitantes de Lubumbashi (République Démocratique du Congo). Impact du paludisme et des helminthiases intestinales.

OBJECTIVE: To determine the prevalence of anemia and associated factors (malaria and intestinal helminthiasis) in high risk groups of Lubumbashi, Congo, particularly in pregnant and breast-feeding women and children aged 1-2 years. MATERIAL AND METHODS: From March to May 2002, 632 pregnant women, 570 breast-feeding women, and 570 infants (1-2 years) were examined in three medical centers in Lubumbashi, Congo. Some of the subjects lived in deprived semi-urban areas (Bongonga and Sendwe), others in urban areas with a satisfactory socio-economic situation (University Clinic). RESULTS: Overall frequency of anemia was estimated between 50 and 80% in the study populations. The proportion of anemic cases was clearly higher in the Sendwe and Bongonga populations (70-80%) than in the other urban populations (50%) (P<0.01). For the three categories of examined subjects, anemia was found to be most prevalent among pregnant women (P<0.05). Anemia was found to be associated with malaria in 40% of the patients and with intestinal parasitism (ascaris / ankylostoma) in 9%. CONCLUSION: Considering these results, systematic screening and treatment of anemia and associated factors such as malaria and intestinal helminthiasis is needed for the Lubumbashi population.

[Anemia associated with malaria and intestinal helminthiasis in Lubumbashi]. / Anémie associée au paludisme et aux helminthiases intestinales à Lubumbashi.

The purpose of this study is to evaluate and determine the prevalence of anemia and associated factors (malaria and intestinal helminthiasis) in some high risk groups, especially in pregnant and breast-feeding women and in children aged 1-2 years old from within a deprived semi-urban population of Lubumbashi (Bongonga and Sendwe). These results were compared to those obtained from an urban population having a more satisfying socio-economic situation (University Clinics). The overall frequency of anemia in the subjects studied from the three centres varies from 50-80%. The proportion of anemic cases is clearly higher in the Bongonga and Sendwe populations (70-80%) than in that of the urban group (50%) (P < 0.05). Among all of the subjects examined, pregnant women are found to be the group with the highest proportion of anemic patients (P < 0.05). All things considered, anemia is associated with malaria in 40% of the cases and with intestinal parasitism (Ascaris and/or Ankylostome infestation) in 9%. Faced with such a situation, the strategy to fight against anemia and associated parasitosis demands and requires multi-disciplinary actions centred on health education, collective screening and specific anti-parasite treatment.

[Prematurity and infant-parent attachment disturbances. Assessment and intervention]. / Le prématuré confronté aux troubles de l'attachement parents-enfant. Prévention et prise en charge.

Premature birth is a factor of impaired infant-parent attachment. In addition it is frequently associated with other factors of impaired attachment related either to the infant (mainly the various pathologies of the premature infants and the hospitalization) and/or to the parents, specially the mother. The main characteristics of the normal process of infant-parent interaction are described as a basis for the early recognition and assessment of impaired interaction and preventive intervention.

Adaptation in neonatology of the once-daily concept of aminoglycoside administration: evaluation of a dosing chart for amikacin in an intensive care unit.

BACKGROUND: The bactericidal efficacy of aminoglycosides is directly related to peak serum concentration (Cmax), particularly the first one. Transitory high concentrations of aminoglycosides do not result in such a high drug uptake by renal and cochlear tissues because of the saturation of cell binding sites. These observations have led to the concept that less frequent administration of relatively larger doses of aminoglycosides would be of interest in treating infectious diseases. OBJECTIVE: Prospective evaluation of a dosing chart of amikacin (Ak) in high-risk neonates suspected of infection within the first 2 days of life. This dosing chart was based on a previous pharmacokinetic population study published elsewhere, treated accordingly to the new once-daily concept of aminoglycoside administration. STUDY DESIGN: One hundred and seventy-seven neonates (69 females and 108 males; mean gestational age (GA +/-SD: 33.6 +/- 4.1 weeks (W) received Ak regimen dosage according to the following dosing chart: Group (Gr) 1a GA <28 W: 20 mg/kg/42 h; Gr 1b GA 28 /= 37 W: 15.5 mg/kg/24 h. In case of asphyxia, hypoxic episode and intercourse treatment with indomethacin, the interval was systemically increased by 6 h whatever the GA groups. The mean duration time of Ak treatment (+/- 1 SD) was 5.00 +/- 2.01 days (range 2-13). Ak serum concentrations 1 h after completion of 30 min infusion (C1h), and successive Ak serum concentrations just before next administration depending on the difference of interval between each group (so defined minimum serum concentration (Cmin)), were determined in each neonate. Creatininemia during the fist postnatal weeks was used as an index of glomerular filtration rate; brainstem auditory evoked potentials (BEAPs) were used in 139 babies when reaching a postconceptional age of >/= 36 weeks to assess possible ototoxicity, and were compared to values from a group of term and a group of preterm babies, previously defined as our reference control groups. RESULTS: At day 1 of treatment, there was no correlation between the Ak C1hS and the GA at birth (mean 27.8 +/- 5.21 microgram/ml (+/- 1 SD); median 28; r = -0.003; range 10-40). In the same way, there was no correlation between the first Ak CminS and the GA at birth (mean 3.7 +/- 2.0 microgram/ml (+/- 1 SD); median 3.0; r = -0.33; range 0-10). The lack of correlation between these first observed C1hS and CminS and the GA at birth suggests the validity of our previous established dose regimen recommendations. Analyzing the data between groups, the mean value +/- 1 SD of Ak C1hS at day 1 of treatment was not significantly different (p > 0.05). Concerning the first Ak CminS, a significant difference (p < 0.01) was only observed when comparing groups 1a, 1b and 2 to group 4. However, this significant difference disappeared when comparing the successive next Ak CminS between groups while each interval remained the same, suggesting a positive postnatal maturation of the renal clearance. In the same way, creatininemia showed a significant and normal decrease (p < 0.01) in each group during the first postnatal weeks. Threshold values of BEAPs at 30 dB showed no significant difference (p > 0.05) between the treated groups (preterm group and term group) and the corresponding control groups. While the primary aim of the study was not to test the bactericidal efficacy of this new regimen, the recovery was excellent in 37 babies with proven or highly suspected infectious disease, except in 1 of them who died from septic shock (group B Streptococcus). After 5 years of using this kind of Ak administration in the unit, minimal inhibitory concentration profiles tested in 43 successive bacterial strains collected from inborn patients remained adequate. (ABSTRACT TRUNCATED)

High-frequency oscillatory ventilation in neonatal RDS: initial volume optimization and respiratory mechanics.

To determine whether initial lung volume optimization influences respiratory mechanics, which could indicate the achievement of optimal volume, we studied 17 premature infants with respiratory distress syndrome (RDS) assisted by high-frequency oscillatory ventilation. The continuous distending pressure (CDP) was increased stepwise from 6-8 cmH2O up to optimal CDP (OCDP), i.e., that allowing good oxygenation with the lowest inspired O2 fraction. Respiratory system compliance (Crs) and resistance were concomitantly measured. Mean OCDP was 16.5 +/- 1.2 cmH2O. Inspired O2 fraction could be reduced from an initial level of 0.73 +/- 0.17 to 0.33 +/- 0.07. However, Crs (0.45 +/- 0.14 ml . cmH2O-1 . kg-1 at starting CDP point) remained unchanged through lung volume optimization but appeared inversely related to OCDP. Similarly, respiratory system resistance was not affected. We conclude that there is a marked dissociation between oxygenation improvement and Crs profile during the initial phase of lung recruitment by early high-frequency oscillatory ventilation in infants with RDS. Thus optimal lung volume cannot be defined by serial Crs measurement. At the most, low initial Crs suggests that higher CDP will be needed.