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Biomedical subjects

D Oriot

Publications and source records attributed to D Oriot.

At least 19 recordsLinked to original sources
PubMed1998

[Use of the intraosseous route in a premature infant].

BACKGROUND: The intraosseous route (IOR) is a rehabilitated vascular access in emergency situations. Its indications and duration are defined, although the age limit at which it is usable is not clearly established. CASE REPORT: A 34-week-old preterm neonate, without infection, receiving gastric gavage, developed, at 8 days of life, a severe septic shock requiring ventilatory support and emergency volume expansion via a subclavian catheter. During the chest X-ray to check its position, the catheter was unfortunately pulled out. The child presented an acute desaturation with bradycardia, requiring bag ventilation and endotracheal epinephrine. The umbilical vein being unusable, an intraosseous access (20 G, distal hole, Cook) was performed at the upper tibial level to continue resuscitation and left in place for 14 hours to infuse antibiotics, inotropic support, blood products and colloids. Blood cultures grew Klebsiella pneumoniae. After a severe initial phase, course was favorable with normal examination at 3 years without complication of the IOR. DISCUSSION: To our knowledge, it is the youngest child in whom IOR was performed. For neonates and especially preterms, the site of puncture is just below the tibial superior tuberosity, otherwise there is a risk of fracture of the diaphysis. This risk justifies the control of the IOR by X-ray. The place of the IOR among emergency vascular accesses in neonates, seems to us to be reserved to situations when umbilical vein is unusable. CONCLUSION: Although no study compared IOR to superior longitudinal sinus access, we suggest to reserve the sinus access only when IOR has failed, because of its potential cerebral complications.

Diseases in Twins↗
PubMed1998

[Intracranial hypertension in the infant: from its physiopathology to its therapeutic management].

The pathophysiology of elevated intracranial pressure (ICP) is assessed from a three cerebral compartment model and from brain compliance. The mechanisms leading to elevated ICP (expanding process, cerebral edema, brain swelling, hydrocephalus) and their consequences (brain herniation, ischemia-anoxia phenomenon, Cushing reaction and neurogenic pulmonary edema) are overviewed. The causes of elevated ICP in children are reported with emphasis on traumatology. Diagnostic procedures include clinical assessment, fundoscopy, cerebral computerized tomography scan and specific problems of cerebrospinal fluid investigation. Methods and results of intracranial pressure monitoring are reported. The treatment of elevated ICP is based upon clinical follow-up and monitoring of ICP. General therapeutic rules consist of adequate position, suppression of any neck, skull and abdominal compression, stimuli limitation and fluid restriction. Specific treatments include mechanical ventilation, sedation and analgesia, barbiturates, anticonvulsant drugs, mannitol, corticosteroids, hypothermia, enteral nutrition, and antibiotics.

Analgesia↗
PubMed1998

[Why pediatric consultations increase in the centers for the socially excluded?].

Studies done by Médecins du Monde indicate that sanitary exclusion is a growing phenomenon in France, children included. Paediatricians must be concerned by this phenomenon, which is related to the social precarity of many families who do not use the standard health care structure. They must understand the reasoning behind the choices of these families, and be involved in the care of their children in places that they accept to visit. Paediatricians should also be present in institutions, conferences and debates where public health policy is discussed in order to defend the place of paediatrics in the sanitary organisation.

Adolescent↗
PubMed1998

[Bacteroides fragilis meningitis revealing a meningorectal fistula].

UNLABELLED: Cases of meningitis due to Bacteroides fragilis are rare; we report a case revealing a meningorectal fistula. CASE REPORT: A 2-month-old infant developed a severe sepsis syndrome following a rectosigmoidoscopy for rectal bleeding. Lumbar puncture diagnosed bacterial meningitis. Cerebrospinal fluid (CSF) culture evidenced B fragilis with betalactamase. The initial antibiotherapy was changed for imipenem-metronidazole, which is at present the recommended antibiotherapy. Malformation including pre-spinal tumor and meningorectal fistula was evoked on magnetic resonance imaging (MRI) and confirmed by surgery. The outcome was favorable after surgery and antibiotherapy. CONCLUSION: B fragilis meningitis are usually associated with sepsis, whose origin is obvious. In our case, meningitis was isolated, revealing a meningorectal fistula.

Bacteroides Infections↗
PubMed1998

Prone position may increase temperature around the head of the infant.

Recommendations to adopt the supine position were followed by a dramatic decrease of SIDS. But no explanation has been given for the association between SIDS and the prone position nor for its decrease in the supine position. We report data on an infant and a mannequin demonstrating an increase in temperature around the head in the prone position. A 4-month-old boy presented an acute life-threatening event related to temperature after febrile otitis despite treatment: 40.5 degrees C, heart rate 280 bpm with circulatory failure and cardiorespiratory arrest requiring resuscitation. There were no seizures. Blood and CSF cultures were negative. The course under antibiotics was favourable. On d 3, we measured temperature at several sites on and around the heat. Temperatures were higher in the prone than in the supine position in pericephalic areas: +1 degrees C (supracephalic), +2.5 degrees C (peritemporal), and +3.5 degrees C (submandibular). In a thermoregulated room, we used a mechanically ventilated mannequin of an infant. The prone position was also associated with an increase in temperature around the head: +3.3 degrees C (supracephalic), +1.8 degrees C (peritemporal), and +1.1 degrees C (submandibular). Changing from the supine to prone position thus increased temperature around the head (infant and mannequin). To our knowledge, this has not been reported before. SIDS is related to factors modifying temperature status and environment. Furthermore, evacuation of heat is mandatory for an infant. We think the increase in temperature around the head in the prone position is due to the absence of convective fluxes, and speculate it could impair thermolysis.

Body Temperature↗
PubMed1996

[What is the choice of training in neonatal intensive care? Analysis of wishes from 106 neonatologists].

BACKGROUND: Improvement of the care to the neonate relys on an increased number of pediatricians in nurseries and adequate neonatal resuscitation training. METHODS: A questionaire about the optimal modes of neonatal resuscitation training was sent to 132 pediatricians in charge of a neonatal unit or a neonatal intensive care unit. Response rate was 80.3%. RESULTS: The training program was targeted to be regional for the organization and for the evaluation. Nevertheless, 41% of answers also favored local evaluation. Duties in neonatal intensive care unit or transportation system, with differences among areas, were the proposed training choices. The pediatrician was considered to be the first person as an instructor and also as a learner in a multidisciplinary training program. Cooperation between primary and tertiary centers physicians was proposed as the best way for training. Proposed criteria for evaluating training efficacy included neonatal mortality and meconium aspiration syndrome rates. Government funding was suggested in 92% of answers. CONCLUSION: It seems necessary to perform a wide neonatal resuscitation training program. This multidisciplinary approach should be regional and follow the guidelines of the neonatal study group.

France↗
PubMed1996

[Evaluation of the views of 189 mothers on the sensory capacities of their newborn infants. Can the information be a tool for prevention?].

UNLABELLED: IS INFORMATION A TOOL FOR PREVENTIVE ACTION? The aim of this study was to evaluate maternal beliefs concerning neonatal performances, to compare them with currently accepted knowledge and to analyse parameters that could influence the maternal judgement. POPULATION AND METHODS: A total of 189 mothers in the postpartum period were prospectively questioned about their beliefs concerning the developmental visual, auditive, olfactive, gustative and sensitive functions of their neonates. RESULTS: Only 57.7% of mothers agreed with the fact that their neonates were able to see. Similarly, there were more than 80% for the olfactive and gustative function and more than 90% for the auditive function and pain discrimination. Multiparity and high level of professional activities improved the mothers' answers about the visual abilities of their neonates. Scientific information through media appeared poorly assimilated. CONCLUSIONS: The time spent by the mothers in the maternity home or word could be used to inform them.

Adult↗
PubMed1996

[Neurologic manifestations in a child of a mother with gestational herpes].

BACKGROUND: Herpes gestationis in the neonate is usually associated with an increased risk of premature birth and/or low birth weight for gestational age (GA) and sometimes skin lesions. Neurologic manifestations are nos described in these babies. CASE REPORT: A boy was born at 35 weeks of GA from a mother who developed skin eruption typical of herpes gestationis. His weight was 2320 g and his height was 46 cm. He had transient respiratory distress syndrome and was given antibiotics due to suspected group B streptococcus infection. He developed on day 3 skin vesiculous eruption which disappeared within 3 days and neurologic manifestations: hypertonia and hyperkinesis, abnormal EEG. The CSF was normal. The manifestations spontaneously disappeared within 5 days. The herpes gestationis factor was present in both mother and infant. CONCLUSION: A relationship between the maternal herpes gestationis and neonatal neurologic manifestations is possible; there was no other known causes for the transient neurological disease.

Female↗