Les infections nosocomiales en réanimation néonatale et pédiatrique. Intérêt de la ciprofloxacineNosocomial infections in neonatal and pediatric intensive care. The appeal of ciprofloxacin.

Nosocomial infections, caused by multiresistant bacteria, are very common in neonatal intensive care units (NIU) and they engage the vital prognosis. MATERIAL AND METHODS: From January 1994 to December 1995, 29 children suffered from nosocomial infections due to multiresistant bacteria. RESULTS: Bacteria were isolated in blood cultures and/or in cerebrospinal fluid and included Klebsiella (14 cases), Enterobacter (eight cases), Pseudomonas (three cases), Acinetobacter (one case), Stenotrophomonas maltophilia (one case) and Flavobacterium odorantum (one case). After preliminary antibiotic therapy, ciprofloxacin was introduced and associated with another antibiotic for 10 days. Outcome was favorable in 25 cases with sterilization of blood culture. Four deaths were due to acute respiratory failure. One case of skin rash and five cases of transient thrombocytopenia were observed during the six days of ciprofloxacin therapy. No articular complication and no dental abnormalities were observed during the 14-38-month follow-up. Ciprofloxacin appears to be a good therapeutic choice for the treatment of severe nosocomial infections in NICU. Side effects are rare, mild, and transient. However, the prevention of nosocomial infection remains essential.     

Ischémie de la main révélant une maladie de KawasakiDistal arm ischemia revealing Kawasaki disease.

An aneurysm of the medium arteries is one of the major complications of Kawasaki syndrome. Eleven cases of giant coronary aneurysm have been reported. Case report. – We report a new case in a nine-month-old child. Ischemia of the left hand was the first symptom. Diagnosis was made 30 days later. Anticoagulant and fibrinolytic treatments did not prevent necrosis of four fingers. Conclusion. –The prognosis of Kawasaki disease depends on early diagnosis and management. Infants younger than seven months of age are more susceptible to developing coronary and mid-artery aneurysms, which therefore justifies a close observation during the acute phase and later on. In the case of a coronary artery aneurysm, Doppler echography of the upper and lower limbs is mandatorily recommended. Anticoagulant therapy should be started once the diagnosis of mid-artery aneurysms is made. Ischemia of the extremities can lead to necrosis and amputation. Until now, anticoagulants, vasodilators and fibrinolytic agents were not proven to be effective.     

Comportements des mères face à la position de couchage de leur bébé : effets de la dernière campagne de prévention concernant la mort subite du nourrissonMothers’ behaviors regarding infant sleeping position: effects of the last public education campaign for sudden infant death syndrome.

BACKGROUND: To define infant care practices in maternity units and those subsequently adopted at home. Using these data, we evaluated the acceptance and application of recommendations issued by the previous public education campaign on infant sleeping position as related to sudden infant death syndrome. PATIENTS AND METHODS: A survey was carried out in two maternity units (Port-Royal and Créteil) and in one pediatric consultation unit (affiliated with Port-Royal maternity). RESULTS: The mixed position (side or back) is used equally with, respectively, 47% at Port-Royal and 45% at Créteil. The supine sleeping position (French public health recommendations) is used by 12% of the mothers at Port-Royal and by 40% at Créteil. It appears that hospital nurseries play an important role in determining the mother's preference for the sleeping position (64% at Port-Royal and 54% at Créteil), but it does not adequately explain all mothers' responses. However, as the infants mature (> two months old), the more spontaneously they changed their sleeping position. All the infants placed in a side sleeping position moved to a supine sleeping position during the night. Upon awakening, infants were found mostly in the supine position (in contrast to the national public education campaign). CONCLUSION: Our results show that mothers and hospital nurseries were distressed in terms of ensuring the supine sleeping position of the infant. New choices of sleeping positions were initiated by mothers. For example, they used the side position after feedings essentially in the case of reflux or during the daytime. The supine position was used when the mothers were assured that any problems had been avoided or only during the night.     

Évaluation de la réponse antipyrétique à 30 minutes de l'ibuprofène suspension aux urgences pédiatriquesAntipyretique activity of ibuprofen syrup in children emergency unit

The ibuprofen, a synthesis inhibitor of prostaglandin, has antipyretic effectiveness considerably studied and proved in the child.Objective. – The purpose of this study is to rate the precocious, total antipyretic effectiveness and in high fever (T ≥ 39.5 °C), of the pediatric population attending a children emergency unit. It is about a prospective study of 1120 feverish children collected between 1st August and 31st December 2001, at the Casablanca children emergency unit. The criteria of inclusion consisted of, the age between 6 months and 12 years old, a temperature ≥ 38 °C and the absence of previous use of antipyretics. The rectal temperature has been taken by a mercury thermometer. The posology used was about 10 mg/kg once. The rectal temperature has been controlled 30 min after the administration of the ibuprofen.Results. – The mean age was 40.8 months and the average of initial temperatures was 38.76 °C. The average of temperature decreased from 38.76 to 38.15 °C in 30 min (P < 0.05). In the group of children (n = 203) who suffered from high fever (T ≥ 39.5 °C), the average of temperatures went down from 39.83 to 38.93 °C in 30 min (P < 0.05). We did not notice any difference of effect concerning age.Conclusions. – This study confirms the effectiveness and the precocity of the antipyretic effect of the pediatric suspension ibuprofen in a children emergency unit.     

Intérêt de la stimulation œsophagienne dans les syndromes de préexcitation ventriculaire du grand enfant

INTRODUCTION: In case of an accessory pathway, children are exposed to severe cardiac events including sudden death. Radiofrequency ablation is a standardized procedure, which can be applied to a significant number of children although complications can still potentially occur. In this context, transesophageal evaluation of the accessory pathway evaluation can be discussed. MATERIALS AND METHODS: Among 140 procedures performed in 19 years, 70 were done for accessory pathway evaluation. The preexcitation was overt in 59 children older than 5 years, which form the basis in this study. RESULTS: Anterograde refractory period was determined in 88% cases and was found<220 ms in 12 cases justifying an ablation procedure. Conversely, in case of a long refractory period (>250 ms), the ablation procedure was not performed in 8 asymptomatic cases and was postponed in 11/20 mildly symptomatic children. Transesophageal electrophysiologic study seems legitimate in asymptomatic or mildly symptomatic children. CONCLUSION: This technique is probably less useful in case of an overt preexcitation and recurrent reciprocating tachycardia requiring long-term antiarrythmic treatment. In this case, endocavitary electrophysiological study eventually followed by an ablation procedure seems the best option.