Épidémiologie du syndrome hémolytique et urémique aigu postdiarrhéique de l'enfant dans quatre départements français

Background.

Epidemiology of the hemolytic uremic syndrome (HUS) is best known in the English-speaking countries than in France.

Population and methods.

The attack rate of the HUS following acute gastro-enteritis in children was studied between 1982 and 1993 in four French departments (total population: 1,758,000). Investigations were performed with the cooperation of all the pediatric hospitals in each department. The pediatric population (0–4 years of age) remained stable at 4.8 to 5.3% during the study. Forty-nine children (22 girls, 27 boys) were included in this retrospective study.

Results.

All patients had hemolytic anemia with schizocytosis; thrombocytopenia was observed in 46/49 cases. Acute renal failure occurred in 48 cases. Twenty-five children required peritoneal dialysis (cumulative duration = 339 days). Four children (8.1 %) died. One patient is still in chronic renal failure after 3 years. Age at disease was less than 1 year in 18 cases, 1–2 years in 13, 2–3 years in nine, 3–4 years in six and 4–10 years in three. The attack rate for the 1982–1993 period for the patients less than 5 years of age was 51.7/100,000 (50.2–54). The mean of annual attack rate in the same group was 4.61/100,000 (range: 1.1–11.3), higher than the annual attack rate of acute HUS in Great Britain (3.1/100,000), Canada (3.1/100,000) and USA (2.7/100,000).

Conclusions.

The attack rate of HUS was similar inside each department even though country vs city dwellers and liverstock were unequally distributed.     

Évolution 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 LFT 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) (165 ± 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 ≥ 60% (P < 0.05; r = 0.54).

Conclusions.

This study shows prolonged clinical and functional abnormalities of the respiratory functions requiring longer follow-up.     

Paludisme sévère de l'enfant au Togo

Background

The definition of severe malaria is no longer limited to cerebral malaria, but is as well extended to other clinical forms of the disease. This work analyses epidemiological, clinical and evolutive aspects of severe malaria in Togo.

Patients and methods

This study included 549 children, aged from O to 15 years, hospitalized in 1994–5 in the pediatric department of the Lome-Tokoin University Teaching Hospital for severe malaria as defined by World Health Organization (WHO) criteria.

Results

The hospitalization frequency was 7.44%; the maximum frequency was from 1 to 5 years of age, but 6.56% of patients were more than 10 years old The most frequent clinical form was that of severe anemia, fallowed by cerebral complications, as seen in many African countries. The death rate was 18.94% and the proportional mortality was 8.21%; 2.73% of the patients had neurological sequelae (behaviour disturbances in five cases, aphasia in four, hemiplegia in three, munchment in one, oculomotor paralysis in one, and cerebellar ataxia in one). Hypoglycemia was fairly frequent (11.6%) and was associated with a poor prognosis.

Conclusion

It is possible to improve severe malaria prognosis in Africa by insisting not only on better equipment in intensive care wards, but also on improved and early management of hypoglycemia.     

L'absence de style est le meilleur style en rédaction médicale

The author describes this conception of medical writing. Based upon a critical analysis of articles recently published in the Archives de Pédiatrie, he underlines the main principles which have to be respected for the writing of a medical article. This paper will be completed in an article entitled « The different redactional forms in medicineto be published in the next issue (January 1988) of the journal.     

La ventilation à l''Ambu chez le nouveau-né : une simple question de doigté ?

Insuflation pressures were measured during manual ventilation using a neonatal rebreathing bag (Ambu^®) on a manikin. Maximal insufflation pressures were greater than that published or given by the manufacturer, theoretically limited to 30 cm of water at open valve, and that wathever the number of fingers used for the compression of the bag. These results indicate that Ambu^® ventilation, often mandatory for newborn resuscitation, does not simply rely upon the finger-touch of the operator and that it always has a risk of baro and/or volotraumatism.     

Le test respiratoire à Purée-C au cours de l'infection gastrique à Helicobacter pylori chez l'enfant

Helicobacter pylori gastric infection in children is a public health problem. Classical diagnostic tools such as endoscopy are excessively invasive in the usual clinical context. Serology at this age has multiple drawbacks. The urea-¹³C breath test seems today the most appropriate alternative method. The principle of the test relies upon the indirect detection of H pylori through its high urease activity. The test uses a stable (ie, non radioactive) isotope, which allows its repeated use. The main indications are the detection and the follow-up of H pylori infection.     

Peut-on améliorer le sommeil des enfants ? Une recherche action en éducation pour la santé à l'école maternelle

An educational project in nursery schools was carried out with the aim to improve children's sleep. Its effectiveness was tested in terms of awareness of families and length of sleep of children. The method was a prevention trial based on the random division of classes of 3-year old into two groups (intervention group and control group) comprising children enrolled in nursery schools in the Rhône region (France) in 1992. The project, lasting 2 years, relied on physicians from the community (Maternal, Child Health Service and School Health Service), their role being to mobilise the teaching teams, distribute specific teaching tools and raise awareness of families to respect the sleep patterns of children, during routine medical examinations. The study was carried out in 140 nursery schools with 1,500 children in each group. The evaluation was based on the application of a logistical regression model taking potentially confounding factors into account, and an analysis in sub-groups in order to demonstrate the effectiveness of intervention on particularly exposed groups. The results show: 1) the feasability of such an intervention among nursery school children on a large scale, 2) the effectiveness of the action, with a reduction of the risk of “poor knowledge” among parents (OR = 0.76), particularly in urban areas, and a reduction in the risk “short nights” in the sub-group of children who had “little sleep at 3 years” in low social class families (OR = 0.50).