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Biomedical subjects

A Dumonceaux

Publications and source records attributed to A Dumonceaux.

6 recordsLinked to original sources
PubMed2001

[Rehydration modalities for acute diarrhea in hospitalized infants. Impact of a permanent short-stay pediatric observation unit].

OBJECTIVE: To analyze hospital treatment of infants with acute gastroenteritis, especially the variations in modes of rehydration, hospitalization rates and lengths of stay, related to paediatrician permanency with a short-stay observation unit at their disposal. METHODS: This prospective multicentric study during two rotavirus epidemic periods included 1,187 infants (mean age 10 +/- 6 months) with acute gastroenteritis resulting or not in dehydration. During the first period, 12 volunteer hospitals were included. During the second period, we compared six (among the 12) hospitals where infants were admitted in emergency care or pediatric units without pediatric 24-h permanency, with a pediatric emergency care unit having pediatric permanency with a short-stay observation unit. RESULTS: During the first period, 32% were dehydrated and 6% had hypovolemic shock on admission. The hospitalization rate was 81%. Only 19% of dehydrated infants had exclusively oral rehydration, and 19% of normohydrated infants had intravenous rehydration. During the second period, the hospitalization rate was 42% in the pediatric emergency care unit (28% in the short-stay unit and 14% in hospitalization units) versus 77% in the six hospitals. In the pediatric emergency care unit as compared to the six hospitals, there were a reduction of 65% of hospitalization days, 58% of intravenous accesses, and 66% of laboratory tests. CONCLUSION: Our findings suggest that a paediatric permanency with a short-stay observation unit at their disposal improves quality of treatment and is cost-effective.

Cost-Benefit Analysis↗
PubMed2000

[Acute bronchiolitis in infants].

Bronchiolitis is the most common disease of the respiratory tract during the first year of life, and occurs in annual epidemics in winter. The etiology is viral, and respiratory syncytial virus (RSV) is the commonest agent. Respiratory symptoms remain generally mild, and treatment just supportive and at home. Certain infants are at high risk of severe illness (age less than 3 months, preterm birth, neonatal respiratory disease, bronchopulmonary dysplasia, underlying chronic diseases), and require hospitalisation. Most treatments are of unproved (corticosteroids), or limited benefit (inhaled bronchodilators, antibiotics). Chest physiotherapy is indicated in case of bronchial secretion. Vaccine are not now available, but prophylaxis with human RSV immunoglobulin or monoclonal antibodies has to be considered for children at increased risk for severe disease.

Acute Disease↗
PubMed1999

[Impact of vaccination against Haemophilus influenzae on the incidence of invasive infections from Haemophilus influenzae type B in the Nord-Pas-de-Calais region].

BACKGROUND: In industrialized countries where immunization against Haemophilus influenzae b (Hib) is largely used, the incidence of invasive Hib infections has dramatically decreased. The aim of this study was to analyse the impact of immunization against Hib on the incidence of invasive Hib infections in the Nord-Pas-de-Calais area in France. PATIENTS AND METHODS: This retrospective multicenter study enrolled 11 of the 18 hospitals in the Nord-Pas-de-Calais area, comparing two periods: 1991-1993 (before immunization), and 1994-1996 (during immunization). All children less than 60 months of age and having an invasive Hib infection were included. The Pasteur-Mérieux Company was asked to provide the number of vaccines sold in the Nord-Pas-de-Calais area during the study period. RESULTS: The number of vaccines sold in 1992 was 56,208; this reached 189,173 in 1996, corresponding to an immunization ratio higher than 90%. One hundred and two children representing 155 invasive Hib infections were studied. The annual incidence was 42 during the first period (meningitis: 18.6; septicemia: 14.6; epiglottitis: 5.6), and nine (meningitis: 5; septicemia: 2.6; epiglottitis: 0.3) during the second period, that is a 78% decrease. CONCLUSION: These results confirm previous data in the literature by demonstrating that immunization in the Nord-Pas-de-Calais area has dramatically decreased the incidence of invasive Hib infections.

Bacteremia↗
PubMed1998

[Trichobezoars in children and adolescents].

BACKGROUND: Trichobezoars are composed of hair or fibres. The typical patient presenting with a trichobezoar is an adolescent girl experiencing mental disturbance or retardation. CASE REPORT: Three girls with trichobezoars were seen. Two of them, 4 and 15 years old, had serious digestive antecedents (corrosive oesophagogastritis and oesophageal atresia, respectively) and had undergone previous surgery. The third was a 13-year-old mentally retarded girl. In two cases, an enzymatic dissolution trial was unsuccessful, requiring secondary surgical removal after, in one case, ineffective gastroscopic removal complicated by an oesophageal perforation. The third child had an initial operative removal. DISCUSSION: Serious digestive antecedents may favour bezoars, a diagnosis that must be evoked in such patients presenting with chronic digestive symptoms. Enzymatic dissolution is ineffective for large bezoars, and gastroscopic removal carries some risks such as perforation or intestinal obstruction. Operative removal is usually indicated. Psychiatric follow-up is needed to prevent this complication in children with serious digestive antecedents and to reduce the risk of recurrences.

Adolescent↗
PubMed1997

[Evaluation of the ambulatory treatment of acute diarrhea in infants. Réseau interhospitalier d'evaluation des pratigues médicales dans les affections courantes de l'enfant].

BACKGROUND: Gastroenteritis remains a common and expensive illness. Oral rehydration solutions (ORS) have been shown to be effective in the prevention and treatment of dehydration, the prime cause for diarrhea-related morbidity and mortality. OBJECTIVE: To evaluate the ambulatory management of acute gastroenteritis in infants, and particularly practices concerning oral fluid therapy. METHODS: This prospective, multicenter study included 326 infants (mean age: 10 +/- 6 months), examined in a hospital for acute gastroenteritis, with or without dehydration. RESULTS: Before admission, 81% had previously been examined by a practitioner, and 89% of these practitioners had written a prescription. This prescription included ORS in 35% and was not different according to the age of the infant. Pediatricians prescribed ORS more frequently than general practitioners (respectively 58% vs 29%; P < 0.001). The failure rate of ORS prescription was 25% (two parents did not observe, ten children refused to drink, and eight stopped treatment because of vomiting). Lactose-free milks were prescribed in 46% of infants and the observance was 82%. At least one drug was prescribed in 94% of infants, with a mean of 2.6 drugs per infant; one antibiotic was prescribed in 33% of infants. Infants were admitted to hospital without any previous consultation in 18%, on the parents' initiative but after at least one previous medical examination in 52%, and on the physician's initiative in 30%. Thirty-three percent were dehydrated; one infant died and two had sequellae. CONCLUSION: The use of ORS remains insufficient. Efforts to improve use of ORS should be expanded beyond physician education.

Acute Disease↗