[Community-acquired bacterial meningitis in the Loire-Atlantic region: evolution of pneumococcal and meningococcal sensitivity to penicillin].

Objectives: An epidemiological study of community-acquired bacterial meningitis was conducted in Loire-Atlantique in subjects aged over 1 month. Risk factors and changes in pneumococcal and meningococcal susceptibility to betalactams were analyzed.

Patients And Methods: All cases of proven or presumed bacterial meningitis registered by Loire-Atlantic bacteriology laboratories between May 1995 and April 1998 were analyzed.

Feasibility of using finger arterial pressure in neonates.

The feasibility of using a Finapres device to reproduce the beat to beat signal of arterial blood pressure in eight neonates was assessed and compared with intra-arterial measurement of arterial blood pressure in the umbilical artery, using a catheter. The two methods gave similar results. Continuous recording of arterial blood pressure in neonates using Finapres is feasible and reliable.

[Hepatoportal sclerosis: apropos of a familial case].

Background: Hepatoportal sclerosis is uncommon in European countries and its diagnosis is difficult. The etiology remains unknown; its familial origin is probably exceptional.

Case Report: An 18-month-old girl born to a mother with hepatoportal sclerosis had hepatomegaly.

[Bacteriological study in acute otitis media].

Aim: A prospective study on bacteriological epidemiology in acute otitis media was conducted in a pediatric hospital emergency service from January 1993 to October 1995.

Patients: One hundred and fifty-eight children, aged 6 months to 6 years, with an acute otitis media were included. Culturing and cleansing of the ear canal and tympanocentesis for aspiration and culture of the secretions were performed in 118 children (46 of whom had received antibiotics before for 48 hours).

Assessment of spontaneous baroreflex sensitivity in neonates.

Aims: To determine whether it is possible to assess baroreflex sensitivity in neonates by studying only spontaneous variation in systolic blood pressure and heart rate.

Methods: ECG and non-invasive blood pressure signals were continuously studied in 14 preterm neonates (term 29-32 weeks) and five term neonates (term 40-41 weeks). Non-invasive blood pressure measures were obtained using a Finapres placed around the child's wrist.

[Heart and sudden infant death. Anatomopathological study of 100 cases].

Background: Post-mortem examination of infants with sudden infant death syndrome (SIDS) is essential for understanding the cause and/or mechanism of death. This study aims to evaluate the contributions of heart in SIDS.

Population And Methods: Between 1981 and 1990, the CHU of Nantes carried out autopsies on 162 cases of sudden infant death syndrome.

[Hospital transfer of newborn infants in the Loire-Atlantic area (France)].

The rate of neonatal referral from the site of birth to a special care centre is generally related to the conditions of the pregnancy and the status of the neonate. The purpose of this study was to investigate other factors affecting referral including obstetric procedures, and equipment and personnel environment. A prospective survey of the neonatal population in 9 maternity hospital in the Loire-Atlantique area in France was conducted.

Response to dobutamine and dopamine in the hypotensive very preterm infant.

A randomised double blind study was designed to evaluate haemodynamic response to dobutamine and dopamine in 20 hypotensive preterm infants of less than 32 weeks' gestation. Neonates initially received dopamine or dobutamine 5 micrograms/kg/min. If mean arterial pressure (MAP) remained below 31 mm Hg, the infusion rate was increased in increments of 5 micrograms/kg/min.

Intrauterine treatment of thyroid goiters.

A fetal thyroid goiter detected by ultrasonography at 20 weeks of amenorrhea (WA) was diagnosed at 23 WA by a second ultrasound examination and a TSH assay in amniotic fluid. Since a sample of fetal blood at 27 WA showed that hypothyroidism was compensated and that goiter size and amniotic fluid volume were stable, intra-amniotic injection of 300 micrograms of L-thyroxine was delayed until 36 WA. This injection was performed before delivery to avoid potential perinatal complications (dystocia and neonatal respiratory distress) caused by large goiters.

[Evaluation of perinatal policy. Result of a survey about birth in Pays de Loire].

A survey was undertaken in 3 French departments of the Pays de Loire from January 1, 1986 to December 31, 1986. Among the 32,876 neonate (NN) population, the authors studied the 2,753 NN who were hospitalized and a control group of 1,458 NN representative of the population of 30,123 NN who were not hospitalized. Socioeconomic patterns of mothers, of their pregnancies and deliveries were studied in both groups.

[Birth before 33 weeks gestational age. The significance of in utero-to-birth transfer in the Department of Perinatology].

Systematic transfer of any woman presenting a high risk of delivery before 33 weeks of amenorrhea, for birth within a Perinatology department which was 5 advocated since 1985 (especially at 31 and 32 weeks of amenorrhea) in order to minimize the neurological consequences of the haemodynamic disorders induced by the transfer of these premature babies, has permitted to increase to 40 live newborns without any severe sequelae. This improved management, noticed in three departments (121 PNB in 1988, or a 73 p. cent progression in 4 years), must now take place as early as the 25th week and before the stage of imminent birth, in order for the couple mother-fetus to take advantage, in the same location, of physicians (obstetricians and pediatricians) and technical means suitable for this rare and severe pathology that is prematurity.

Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated newborns.

The precise diagnosis of lower respiratory tract infection in the critically ill newborn remains a difficult challenge. The bronchoscopic protected specimen brush (PSB) is a reliable method in intubated adults. Because the bronchoscopic procedure is not generally available for young children, Zucker proposed a blind technique for introducing the PSB into the distal airways.

[Labioglossopexy in Pierre Robin syndrome. Our experiences apropos of 70 cases].

Pierre Robin syndrome is typically characterized by glossoptosis and retrognathia associated with cleft palate, respiratory and deglutition disturbances. Two morphological tendencies arise out of this 70-patient series, 50 of whom were managed with the same therapeutical regimen, which included labioglossopexy and was associated with only one case of death: "deforming" type Pierre Robin syndrome most commonly follows a favorable course with respect to both function and facial deformations, provided labioglossopexy is carried out sufficiently early. Indeed, this surgical operation allows for prompt restoration of normal function, thereby limiting the dysfunction-deformation vicious circle.

[Posology of amikacin in newborn infants, adapted to the postconceptional age].

Two consecutive studies of amikacin plasma levels were performed in 63 and 64 neonates whose postconceptional age (PCA) ranged from 26 to 45 weeks. The first study, using a dose of 7.5 mg/kg every 12 hours, permitted to establish a dosage related to PCA.

[Cephalhematoma infection in neonatal septicemia].

Most cephalhematomas resorb spontaneously; intervention by means of needle aspiration may introduce infection. In our case, a neonatal septicemia was associated with a large parietal cephalhematoma. The newborn was discharged after treatment of sepsis.

[Epidemiological study of severe forms of infectious purpura in 1984. National survey of the Club Français de Réanimation Pédiatrique].

A retrospective national study undertaken by the Club Français de Réanimation Pédiatrique found 103 children hospitalized in intensive care units for severe infectious purpura in 1984, i.e. 1.