[Somatosensory evoked potential of the lower extremity in the premature neonate]. / Potentiel évoqué somesthésique du membre inférieur chez le nouveau-né prématuré.

The morphology of SEP is a good index of cortical maturation. Cerebral SEP is elicited by stimulation of the posterior tibial nerve at 38 wk post-conceptional age in 37 neonates distributed in 3 groups: I = gestational age (GA) at birth less than 31 wk; II = GA 23-36 wk; III = full-term neonates (FTN). A somatosensory response was identified in only 21 cases (56.8%). The presence of SEP in 3 groups, ie I, II, III, was 45.5%, 53.8% and 69.2% respectively. The morphological characteristics studied (latencies, amplitude and rising time) in these neonates were different: the peak latencies of major positive wave (P1) and rising time were not significantly different between I and III. These parameters were statistically different between II and III. SEP development is linked to some morphological factors-height, and growth-but also to the maturation of the central nervous system (myelinisation and central pathway organization). These results indicate that until 38-39 wk post-conceptional age, the maturation of the central somatosensory pathway is variable at different birth periods; this suggest the possible role of extra-uterine factors of in the acceleration of neurological development.

[Future vaccines in parasitology]. / Vaccins du futur en parasitologie.

The major public health problems posed by endemic parasitic diseases and the difficulty of treating these diseases have lead to a concerted effort towards the development of efficient vaccines. Associated immunological phenomena are extremely complex. It is in this area that recent progress has been the most impressive. Despite the failure of antisporozoite vaccine, which had seemed to offer much promise, the role of T-lymphocytes has been clarified. An antimerozoite vaccine utilizing several recombinant surface antigens has produced interesting experimental results. The concepts of an "antidisease" vaccine opens up a number of perspectives. Although immunodepression with respect to visceral leishmaniasis is better understood, there appears little hope for a vaccine, unlike cutaneous leishmaniasis. Immune mechanisms brought into play during schistosomiasis are particular to the disease and offer the potential for useful animal vaccines.

-Vaccination against hepatitis A-. / Vaccination contre l'hépatite A.

A pediatric form of hepatitis A vaccine is available with an immunization schedule of three injections within one year followed by booster injections every 10 years. This schedule gives a marked elevation of protecting antibodies and has a good protective effect against the symptomatic forms of hepatitis A. The vaccine is administered intramuscularly in the deltoid and is usually well tolerated. Major changes have occurred in the epidemiology of hepatitis A in France in the last decades. While many children were affected 20 years ago, hepatitis A is nowadays essentially observed in adolescents and young adults, although there remain symptomatic cases, with very few fulminating cases, among children. Considering the low risk of symptomatic cases, the usefulness of a systematic immunization against hepatitis A in children is questionable, with the exception of polytransfused children and handicapped children living in community. For the travelling children, hepatitis A immunization must be decided according to the travel conditions and the epidemiology of hepatitis A in the visited country.

[Imported malaria in children in France]. / Paludisme d'importation de l'enfant en France.

UNLABELLED: Among the European countries, France is the most affected by imported malaria. The aim of this study was to take stock of the situation of imported malaria in children in France. METHODS: Attacks of malaria in children less than 15-year-old which have been notified to Centre National de Référence des Maladies d'Importation (CNRMI) were reviewed retrospectively between 1995 and 1997 and 1995 and 1998 for severe malaria. RESULTS: Over a period of 3 years, 1256 malaria attacks were notified in children including 90.9% without signs of severity. The mean age was 7 years. Sex ratio was 1.19. About 44.5% were French. Most of the cases were acquired in Africa. Plasmodium falciparum was involved in 79.2% of the cases. About 61.8% of children have been under prophylaxis but only 37.9% admit good compliance. Chemoprophylaxis was frequently inadequate. Halofantrine was prescribed for 76% of these children. Over a 4-year period, 51 children were notified as severe malaria attacks. Among them, 17 had severe malaria as defined by the World Health Organisation criteria. Most of these patients (73%) were treated by quinine by intravenous route. Two children died. CONCLUSION: Paediatric malaria is not rare in France. Only the improvement of prophylaxis could decrease the incidence of malaria in France.

[Comparative study of nebulized sambutol against placebo in the acute phase of bronchiolitis in 33 infants aged 1 to 6 months]. / Etude comparative des nébulisations de salbutamol contre placebo à la phase aiguë d'une bronchiolite chez 33 nourrissons de 1 à 6 mois.

BACKGROUND: The therapeutic role of bronchodilators in bronchiolitis remains controversial. The aim of this study is to evaluate the safety and the clinical response to nebulized salbutamol in infants with mild acute bronchiolitis. PATIENTS AND METHODS: Thirty-three infants, aged 1 month to 5 months and 22 days (mean: 92.4 days) were included in the study. Patients received either nebulized salbutamol (0.15 mg/kg per dose: 16 infants) or a placebo (normal saline aerosol: 17 infants), delivered by an oxygen propellent, three times at intervals of 1 hour, as part of a double-blind randomized trial. Effect of treatment was evaluated by measuring respiratory and heart rate, clinical scores based on the degree of retraction and wheezing, and oxygen saturation. Clinical assessment was repeated 30 minutes after each nebulization. A nasopharyngeal swab was obtained for detection of respiratory syncytial virus (VRS) antigens by immunofluorescence assay in all patients. RESULTS: Patients in the salbutamol group exhibited significantly greater improvement in respiratory rate (P = 0.01), accessory muscle score (P < 0.001) and wheezing score (P < 0.001). There was no significant difference in oxygen saturation between both groups. Infants treated with salbutamol exhibited a non-significant increase in heart rate after the three sprays; no other adverse effects were noted. VRS was identified in 78% of the children tested. CONCLUSIONS: Salbutamol is safe and effective in relieving the respiratory distress of young infants with acute bronchiolitis. Our study confirms previous observations that infants younger than six months of age respond as well as older children when given three doses of nebulized salbutamol. Responders could not be differentiated from non responders by personal or family histories of atopy and VRS isolation. A longitudinal study could establish a correlation between response to bronchodilator therapy and later development of asthma.

[Severe cutaneous Streptococcus pyogenes infections in the child: results of a multicenter survey]. / Infections cutanées sévères à Streptococcus pyogenes chez l'enfant: résultats d'une enquête multicentrique.

UNLABELLED: To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes. Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S. pyogenes has increased in adults. Serotyping of obtained isolates are in most cases M1, M3 or M5 protein. PATIENTS AND METHOD: A retrospective (1990-2000) survey was carried out in pediatric hospital centers. RESULTS: Three cases of necrotizing fasciitis and 15 of cellulitis were observed. In 30% of the cases, vancella lesions were associated; in the other cases, minor wounds were the site of the infection. Bacteriologic diagnosis was made by local samples in 14 cases; blood cultures were positive in four cases. In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid. In the second time, penicillin M was perfused in the majority of the cases. Mean duration of intravenous antibiotics perfusion was 15 days. There were no sequelae or death in this survey. CONCLUSIONS: Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare. The frequency is probably underestimated, due to the difficulty in performing a diagnosis. The major site of infection was the varicella lesion. These two infections are so similar that it is frequent to mistake one infection for the other. Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis. The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.

[Malaria in children in 1990]. / Le paludisme de l'enfant en 1990.

The development of imported cases and the upsurge of resistance to chloroquine have altered the diagnosis and treatment of infantile malaria. The diagnosis may be missed, with a risk of the disease turning into a lethal attack of cerebral malaria. The demonstration of plasmodia in blood smears is the best proof of the disease, but waiting for it should not always delay treatment. Intravenous quinine remains the basic therapy of cerebral malaria. As the distribution of chloroquine-resistant strains is imperfectly known, the prophylaxis and treatment of simple attacks are often difficult. As regards curative therapy, halofantrine seems to be easier to handle than mefloquine, but it is useless for prevention. Preventive measures, including the use of mosquito nets and treatment of febrile episodes presumed to be malarial, are useful additions to the systematic prescription of drugs that are seldom fully effective.