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Biomedical subjects

E Saliba

Publications and source records attributed to E Saliba.

At least 19 recordsLinked to original sources
PubMed2006

[Early management of infants born to mothers with meconium-stained amniotic fluid: a survey in French delivery rooms].

UNLABELLED: The meconium aspiration syndrome is the first cause of respiratory distress in full term newborns. At birth, management includes systematical oropharyngeal suctioning, before and after shoulders delivery, followed by tracheal suction. During last 10 years, many trials were published which discuss again the value of this strategy. AIM: To assess practices of the current management of births with a meconial amniotic liquid in the French maternities. METHODS: Observational survey by written questionnaires sent to the 617 French maternities. RESULTS: The rate of answers was of 54.3%. The incidence of the births presenting a meconial amniotic fluid was of 8.2%, complicated of meconium aspiration syndrome in 4.7%. In case of birth with presence of a meconial amniotic liquid, half of the maternities resorted systematically to oropharyngeal suctioning before shoulders delivery. A glottis exposition under laryngoscopy was practiced of principle for half of the newborn. Tracheal suctioning was achieved systematically in a quarter of the establishments. These techniques, with the exception of suctioning before clearing of the shoulders, were especially been achieved in a systematic way in the maternities of I and II A levels. CONCLUSION: This survey shows the necessity of harmonization of the practices in France for the management of the births with a meconial amniotic liquid.

Amniotic Fluid↗
PubMed2006

[Fetal toxicity of angiotensin-II receptor antagonists].

We report a case of a newborn with an oligohydramnios, acute renal failure and ossification abnormalities. The role of maternal treatment of essential hypertension by angiotensin-II receptor antagonists is discussed in regard to the literature and pathophysiological data.

Acute Kidney Injury↗
PubMed2005

[Metoclopramide and neonatal methaemoglobinemia].

We report the case of a five-day-old newborn with cyanosis. After exclusion of pulmonary and cardiac illness, methaemoglobinemia was diagnosed. Cyanosis is the first symptom of methaemoglobinaemia. Numerous causes of methaemoglobinemia have been described, with congenital and acquired forms, which are the most frequent. We discuss here the clinical features, diagnosis, and treatment of acquired methaemoglobinaemia in newborns with special emphasis on forms secondary to metoclopramide toxicity.

Humans↗
PubMed2003

[Necrotizing enterocolitis and apnoeas-bradycardias of the preterm newborn].

UNLABELLED: We conducted a case control study during six and a half years with the objective to analyse the risk factors for NEC. POPULATION AND METHODS: All cases of confirmed NEC matched to controls for identical gestational age and period of hospitalization; apnoeas-bradycardias prospectively counted. RESULTS: Forty-five cases were compared to 89 controls. The isolated risk factors were: an intra-uterine growth retardation (OR = 3,65, 95% confidence interval [CI] 95%: 1,54-8,63); a birth weight < 1000 g (OR = 8,16, CI 95%: 1,17-56,62), compared to a weight >/= 1500 g; a triple antibiotherapy (OR = 6,15, CI 95%: 1,16-32,45); an umbilical venous catheterization (OR = 2,64, CI 95%: 1,09-6,44); a number of simple apnoeas-bradycardias >/= 3rd tercile (n = 27) (OR = 4,54, CI 95%: 1,29-15,93), or severe (stimulated or with hypoxia) apnoeas-bradycardias >/= 3rd tercile (n = 8) (OR = 6,15, CI 95%: 1,59-23,75); an haemoglobin level lower than the 1(st) tercile (95 g/L) (OR = 5,90, CI 95%: 1,20-20,13); and milk thickening by Gumilk (OR = 2,78, CI 95%: 1,11-6,90). CONCLUSION: In the present practices, anoxo-ischemic factors during the first week of life do not represent an important risk of NEC; a great vigilance must be exercised for indications of the triple antibiotherapy and the treatment of apnoeas-bradycardias.

Apnea↗
PubMed2003

[Medical, cognitive and affective status of four-year-old very premature babies without severe disability. A case-control study].

AIM: To determine cognitive performances and affective development of a cohort of very premature babies at the age of 4 years. POPULATION AND METHODS: Longitudinal case-control study. Newborns less than 33 weeks gestation were included from 1992 to 1994 and were matched with two full-term newborns. At 4 years of age, they have been evaluated for medical status, cognitive functions with the K-ABC test and affective condition with the PSA and Conners' tests. RESULTS: The preterm group was significantly different from the controls for: a smaller height, (P < 0.01), a lower socioeconomic level (P = 0.027), a lower nursery school level (44% versus 27,6%, P = 0.05), the incapacity to draw "a bonhomme" (55,3% versus 93%, P < 0.001), lower performances for the K-ABC and PSA tests, a pathologic Conners score (20.4% versus 2.4%, P < 0.001). Multivariate analysis by logistic regression showed a similar neuropsychological results: a lower score of K-ABC (< 80, P = 0.0006, odds-ratio = 33.2), and a lower social competence score of PSA (< 45, P = 0.004, odds-ratio = 35.9). CONCLUSION: Follow-up of premature babies is required, and measures to prevent or minimize cognitive and social disabilities are mandatory.

Affect↗
PubMed2003

Prevention of Candida colonization prevents infection in a neonatal unit.

This study represents a 1-year surveillance period using our epidemiology-based principles published and successfully followed since 1979: weekly culture for yeasts of oral and anal swabs, treatment with oral nystatin of all colonized newborns, and good hygiene/handwashing. Colonization was demonstrated in 23 out of 791 newborns admitted from October 1998 to September 1999. Twenty-two strains of Candida were identified: 16 C. albicans, 2 C. parapsilosis, 3 C. glabrata, and 1 C. tropicalis. Symptoms were erythema of the buttocks in 6 colonized newborns. No other culture positive for Candida could be found. Previous contamination was the main source (previous stay in an intensive care unit, rarely maternal origin). Contamination in the unit was unlikely. Eradication of Candida could be observed within 1 week. These good results, controversial in the literature, were obtained following epidemiological conclusions and support our guidelines.

Buttocks↗
PubMed2002

Population pharmacokinetics of cisapride in neonates.

OBJECTIVES: We conducted a population pharmacokinetic analysis of cisapride in neonates to study whether metabolic immaturity in this population may lead to increased concentrations. METHODS: Cisapride was administered orally in 91 neonates at the dose of 0.2 mg/kg four times a day. Plasma concentrations were measured using a validated HPLC method. A one-compartment model with first-order absorption was fitted to the data using NONMEM software. RESULTS: One to seven plasma samples were obtained from neonates aged 7-123 days. Cisapride concentrations ranged from 5.5 ng/mL to 172 ng/mL and were not higher than those reported in adults. The absorption constant rate was fixed to 2.5 h-1. Clearance (CL/F) and volume of distribution (V/F) both significantly correlated to weight (WT), but addition of this covariate in V/F did not improve the objective function after it was added in the CL/F covariate model. Prematurity, postnatal age, or coadministered drugs did not affect cisapride clearance. Final population pharmacokinetic parameters (interindividual variability) were: V/F=17,200 mL (90.4%) and CL/F=3.91 x WT(3/4) mL/h (36.3%). CONCLUSIONS: Our finding that cisapride clearance is primarily influenced by weight is in agreement with current recommendations of weight-adjusted doses. This study indicates that no clinically relevant maturational changes in cisapride clearance have to be considered during the first quadrimester of life.

Cisapride↗
PubMed2001

Cerebral white matter damage in the preterm infant: pathophysiology and risk factors.

Based on clinical, epidemiologic, and experimental studies, the aetiology of white matter damage, specifically periventricular leukomalacia (PVL), is multifactorial and involves pre- and perinatal factors possibly including genetic factors, hypoxic-ischaemic insults, infection, excess cytokines, free radical production, increased excitatory amino acid release, and trophic factor deficiencies. The article summarizes research findings about the aetiology of white matter damage and cerebral palsy in preterm infants. The information is organized according to specific antecedents, for which we present epidemiological and neurobiological data. The most important prenatal factor appears to be intrauterine infection. We discuss the evidence supporting the hypothesis that the foetal inflammatory response contributes to neonatal brain injury and later developmental disability. We recently established an animal model of excitotoxic lesions in the developing mouse brain. Brain damage was induced by intra-cortical injections of ibotenate, a glutamatergic agonist. When administered on post-natal day 5 ibotenate induced the formation of white matter cysts. Our animal model could be used to further explore the mechanisms involved in the formation of PVL. Potentially preventive strategies will be discussed.

Brain Injuries↗
PubMed2001

D2 receptor imaging in neonates using I-123 iodobenzamide brain SPECT.

PURPOSE: Hypoxic-ischemic injury induces early changes in cerebral energy that later lead to the presence and extension of brain damage and subsequently to severe neurodevelopmental impairments such as the dyskinetic form of cerebral palsy, which is associated with damage to the striatum. The purpose of the current study was to evaluate the viability of D2 receptors in the perinatal period using I-123 iodobenzamide brain SPECT and to correlate this with early neurologic status. METHODS: After obtaining informed parental consent, 12 full-term neonates with hypoxic-ischemic events were included. I-123 iodobenzamide brain SPECT was performed 1 week after birth, corresponding to a gestational age of 39.2+/-1.7 weeks. Images were acquired using a brain-dedicated gamma camera 1 hour after intravenous injection of 30 MBq (0.8 mCi) I-123 iodobenzamide. Magnetic resonance images (T2 weighted sequence: repetition time/echo time: 2,000/30 to 150) of the brains of the same neonates were acquired on the same day. RESULTS: The right and left striatum:cerebellum activity ratios were between 1.28 and 2.25, with the greatest concentration of I-123 iodobenzamide occurring in the striatum area. A tendency of the striatum:cerebellum ratio to decrease was observed as the severity of the perinatal hypoxic-ischemic event increased despite striatal hypersignal on magnetic resonance imaging in only two neonates. CONCLUSIONS: This study, which confirms that I-123 iodobenzamide could be used in the neonatal period, shows the biochemical maturation of D2 receptors as early as 1 week after birth and also suggests the deleterious effect of perinatal hypoxic-ischemic events on D2 receptors.

Brain↗
PubMed2001

Inflammatory mediators and neonatal brain damage.

Inflammatory mediators are multifunctional cytokines that play important roles both in normal central nervous system (CNS) development and in the response of the brain to diverse forms of injury. Interleukin (IL)-1beta, tumor necrosis factor-alpha and IL-6 are among the best-characterized early-response cytokines. Recent data suggest that they may be synthesized and secreted by several CNS cell types, including microglia, astrocytes and neurons. Biological effects of these cytokines that could influence the progression of injury in the brain include stimulating the synthesis of other cytokines and neuronal injury mediators such as nitric oxide synthase, inducing leukocyte infiltration and the expression of adhesion molecules, influencing glial gene expression and damaging oligodendrocytes. In the immature brain, proinflammatory cytokines might lead to white matter damage during prenatal intrauterine infection and contribute to progressive neuronal damage in acute brain injury evoked by cerebral hypoxia-ischemia. Interrupting the proinflammatory cascade might limit the extent of irreversible injury.

Animals↗
PubMed2000

Auditory attention processing in 5-year-old children born preterm: evidence from event-related potentials.

The assumption that children born preterm have difficulties in maintaining active attention was tested in passive and active tasks. Twenty 5-year-old children born preterm at 26 to 32 weeks gestational age were compared with 20 children born at term, matched for age and IQ, using an auditory paradigm. In the passive task participants had to watch a videotape of a cartoon and ignore auditory stimuli. In the active task they had to detect a rare tone (the 'target' tone; 10% of the tones presented) among frequent tones (the 'standard' tone; 90%). Accuracy and reaction time were analysed, and event-related potentials (ERPs) were recorded at the scalp sites Fz, Cz, T3, T4, Pz, Oz, and two electrodes for the left mastoid (passive task); and Fz, F7, F8, Cz, T3, T4, Pz, and Oz (for the active task). Behavioural and electrophysiological data were analysed with repeated-measure ANOVAs. The results showed a significant group effect only on the active task. The preterm group scored fewer correct hits (correct detection of target tone) and were less efficient in their attentional strategy as assessed by ERP components.

Attention↗
PubMed2000

Predictive factors for complications in children with laryngeal damage at extubation.

OBJECTIVES: To determine which factors contribute to early complications when intubated children show macroscopic lesions at extubation. STUDY DESIGN: Retrospective review of 96 consecutive medical records of children aged 1 day to 15 years. Patients were divided into three groups depending on the extent of the subsequent treatment required: medical, reintubation, and surgical. METHODS: Age, sex, clinical history, and macroscopic features of the lesions were collected and data were compared in each group. RESULTS: Underlying noninfectious respiratory diseases and young age were found to be risk factors for higher incidence of complications, but not prolonged or multiple intubations. Edema, especially in the glottic area, was a risk factor for surgical treatment. Multiple lesions were risk factors for reintubation. CONCLUSIONS: History of intubation, its cause, and lesions discovered at extubation can provide the basis for definition of an "at risk" profile for intubated children.

Adolescent↗
PubMed2000

Lower extremity compensations following anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSES: Several studies have demonstrated that patients with knee injury scored within a normal range during one-legged hop tests, yet showed quadriceps femoris muscle weakness with non-weight-bearing isokinetic testing. This study evaluated lower-extremity kinetics while subjects performed a single-leg vertical jump (VJ) and a lateral step-up (LSU) in an attempt to explain this phenomenon. SUBJECTS AND METHODS: Using a motion analysis and force platform system, hip, knee, and ankle extension moments of 20 subjects with anterior cruciate ligament (ACL) reconstructions and 20 matched subjects were measured while they performed an LSU and a VJ. RESULTS: An analysis of variance revealed that the knee extension moment of the ACL-reconstructed extremity was lower than that of the uninjured and matched extremities during the LSU, VJ take-off, and VJ landing. However, there was no difference in summated extension moment (hip + knee + ankle) among extremities during the LSU and VJ take-off. The summated extension moment of the ACL-reconstructed extremity during VJ landing was less than that of the uninvolved and matched extremities. CONCLUSION AND DISCUSSION: These results suggest that the hip or ankle extensors may compensate for the knee extension moment deficit. The decrease in summated extension moment in the ACL-reconstructed extremity during VJ landing represents inadequate attenuation of landing forces, which may expose the skeleton and joint structures to injury.

Adult↗
PubMed1999

MR assessment of the brain maturation during the perinatal period: quantitative T2 MR study in premature newborns.

The purpose of our study is to trace in vivo and during the perinatal period, the brain maturation process with exhaustive measures of the T2 relaxation time values. We also compared regional myelination progress with variations of the relaxation time values and of brain signal. T2 relaxation times were measured in 7 healthy premature newborns at the post-conceptional age of 37 weeks, using a Carr-Purcell-Meiboom-Gill sequence (echo time 60 to 150 ms), on a 2.35 Tesla Spectro-Imaging MR system. A total of 62 measures were defined for each subject within the brain stem, the basal ganglia and the hemispheric gray and white matter. The mean and standard deviation of the T2 values were calculated for each location. Regional T2 values changes and brain signal variations were studied. In comparison to the adult ones, the T2 relaxation time values of both gray and white matter were highly prolonged and a reversed ratio between gray and white matter was found. The maturational phenomena might be regionally correlated with a T2 value shortening. Significant T2 variations in the brainstem (p < 0.02), the mesencephalon (p < 0.05), the thalami (p < 0.01), the lentiform nuclei (p < 0.01) and the caudate nuclei (p < 0.02) were observed at an earlier time than they were visible on T2-weighted images. In the cerebral hemispheres, T2 values increased from the occipital white matter to parietal, temporal and frontal white matter (p < 0.05) and in the frontal and occipital areas from periventricular to subcortical white matter (p < 0.01). Maturational progress was earlier and better displayed with T2 measurements and T2 mapping. During the perinatal period, the measurements and analysis of T2 values revealed brain regional differences not discernible with T2-weighted images. It might be a more sensitive indicator for assessment of brain maturation.

Adult↗
PubMed1999

ERP evidence of developmental changes in processing of faces.

OBJECTIVES: There is disagreement in the behavioural literature, as to whether face processing undergoes qualitative or quantitative change with age. METHODS: We studied event-related potentials (ERPs) associated with facial processing in 48 children (4-14 years) and 12 adults. Five categories of stimuli were presented: faces, cars, scrambled faces, scrambled cars, butterflies. The butterflies were targets (P = 12%); the other stimulus categories were equally represented and all were non-targets. RESULTS: An N170 was recorded only to the faces at posterior temporal sites and in adults it was largest at T6'. This component was seen across age groups, but at steadily increasing latencies in younger children. Age-related increases in N170 amplitude were found at T6'. In children under 12 years of age, the frontal P170 was not reliably seen. CONCLUSION: This study suggests that the underlying neural basis associated with processing faces matures in a gradual, quantitative manner throughout childhood.

Adolescent↗