[Epidemiology of bacterial meningitis in children in France].
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Biomedical subjects
Publications and source records attributed to J Sarlangue.
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BACKGROUND: We describe three neonates who presented around the tenth day of life with multiple bilateral fluctuating cold abscesses situated in the lymph node areas, with secondary fistulation but without associated fever or general symptoms. RESULTS: In all cases, Staphylococcus aureus was found in the abscesses and the umbilicus with similar antibiograms. The evolution was good and the children remained in good health afterwards. CONCLUSION: Disseminated neonatal staphylococcal infections with a benign evolution are not commonly described in the medical literature. Clinically, cold inflammatory abscesses of the large folds associated with omphalitis may correspond to either transient bacteriemia well controlled in an immunocompetent host or more likely a local contamination process.
OBJECTIVE: The aim of the study was to compare the rehospitalization rate in the first year of life between 2 groups of very preterm infants born on 1997 and 2002; then we compared the very preterm infants' rehospitalization rate between our retrospective 1997 group and literature (including French cohort Epipage). PATIENTS AND METHODS: Our retrospective study included all neonates born<or=33 GA, living in Gironde, discharged from neonatal unit at children's hospital of Bordeaux on 1997 and 2002 and rehospitalized during their first year of life. RESULTS: Respectively 29.1% and 30.1% premature infants were rehospitalized (at least once) in 1997 and 2002 (38.2% in Epipage cohort, no statistical difference). Mean number of rehospitalizations was 1.66 in 1997 and 1.77 in 2002. Mean duration of rehospitalization was 11.8 days in 1997 and 16.8 days in 2002. These data showed no statistical difference between 1997 and 2002. Respiratory disease was the first reason of rehospitalization. Several factors were correlated with an increase risk of rehospitalization: birth weight less than 1000 g, chronic lung disease and gestational age less than 28 weeks at birth (only in 2002 cohort). CONCLUSION: Rehospitalization rate remained stable between 1997 and 2002 whereas during this period of time, the gravity of these preterm infants had increased. The use of specific hospital discharge procedure represents a real benefit for premature infants. It must be continued after the discharge with the establishment of a strong network with the implication of parents, infants, hospital and city health workers. It may contribute to limit the very premature babies' rehospitalization rate.
Incidence of chlamydial infection depends on maternal colonization during pregnancy, which is different in each population. The transmission is not obligatory but when present, it occurs at birth through the genital tractus. Chlamydia trachomatis infection is the first cause of neonatal conjunctivitis, with no influence of eye lotion application at birth. C. trachomatis is also responsible for interstitial pneumonia with possible consequences on the lung function. The laboratory diagnosis relies on the identification of intracellular bacteria in patient samples by the mean of culture or PCR. Systemic antibiotherapy by macrolides is always necessary, with local application in the case of conjunctivitis. The key point is the detection of colonization of pregnant women with identified risk factors. In positive case, oral treatment of both parents is recommended.
UNLABELLED: Life-threatening complications of congenital haemangiomas are rare. A case of haemorrhage in a neonate is reported here. A neonate presented a congenital haemangioma of the limb complicated by a massive life-threatening haemorrhage. Colour ultrasonography showed a hypervascularized, highly haemodynamically active mass with a large, superficial drainage vein just under the ulceration. Surgical resection was performed with satisfactory postoperative outcome and no evidence of recurrence. CONCLUSION: Early surgical removal can be a good therapeutic option for complicated congenital haemangiomas.
UNLABELLED: We report a case of hereditary sensitive neuropathy associated with insensitivity to pain in an infant. CASE REPORT: The girl was born after a normal full term pregnancy. She was hospitalized in the neonatal period because of hypotonia and recurrent cyanotic episodes due to false passage. The diagnosis of insensitivity to pain was suspected at nine months of age, as parallel with dentition, multiple mutilations of the tongue and the fingers were observed. The diagnosis was confirmed by biopsy taken from the sural nerve which showed a rarefaction of small myelinated fibres whereas unmyelinated fibres remained unaltered. At the age of six years, the general condition was good and the neurologic developement was satisfactory, neurotrophic and urologic complications currently being the main problem. CONCLUSION: A multidisciplinary and specialized care associated with parental compliance was necessary to minimize the complications of this potentially severe disorder.
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UNLABELLED: Nonbacterial thrombotic endocarditis is not widely known in neonates. CASE REPORTS: We report three new cases which illustrate some specific aspects of this pathology. Respiratory distress with severe pulmonary hypertension, systemic hypotension and disseminated intravascular coagulopathy in a full-term newborn were characteristic findings. CONCLUSION: An early echocardiography should lead to accurate diagnosis. Hypoxemia and genetic factors could be determining factors in its pathogenesis.
UNLABELLED: We report two cases of osteoarticular brucellosis in childhood, which illustrate the diagnostic difficulties in non-endemic areas. CASE REPORT: A 12-year-old boy was admitted for a unilateral sacroiliitis for which the brucellosis origin was established by serological and blood cultures (without fever). Autoimmunity was detected and disappeared following the treatment of the affection. A six-year-old girl was admitted for a monoarthritis of the left ankle (with fever) for which the brucellosis origin was also established by serology and blood cultures. COMMENTS: The above cases underline the importance of knowing the atypical varieties of brucellosis. The brucellosis serologies need to take part in the etiological workup of an infectious osteoarthritis when a classic infectious cause cannot be proved. Blood cultures on a specific medium are essential to carry out, even in the case of apyrexia. Finally, the possibility of autoimmunity signs for the brucellosis has to be known to avoid orientating the diagnosis towards an autoimmune systemic disease.
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OBJECTIVES: Perinatal hypoxic ischaemic injury is a significant cause of neurodevelopmental impairment. The aim of this study was to evaluate localised proton magnetic resonance spectroscopy (1H-MRS) after birth asphyxia. MATERIALS AND METHODS: Thirty newborn infants suspected of having perinatal asphyxia (Apgar score < 3) were studied. The mean gestational age was 37 weeks, mean age at the MR examination was 18 days and mean weight was 2.9 kg. A 1.5-T unit was used for imaging and spectroscopy. None of the babies had mechanically assisted ventilation. No sedation was used. Axial T1-weighted and T2-weighted images were obtained. 1H-MRS was recorded in a single voxel, localised in white matter, using a STEAM sequence. RESULTS: Image quality was good in 25 of 30 babies. 1H-MRS was performed in 19 of 30 subjects, with adequate quality in 16. Choline, creatine/phosphocreatine and N-acetylaspartate peaks and peak-area ratios were analysed. Lactate was detected in four infants. The N-acetylaspartate/choline ratio was lower in infants with an impaired neurological outcome, but the difference was not statistically significant. CONCLUSIONS: This study suggests that 1H-MRS may be useful for assessing cerebral metabolism in the neonate. A raised lactate level and decreased N-acetylaspartate/choline ratio may be predictive of a poor outcome. However, in our experience this method is limited by the difficulty in performing the examination during the first hours after birth in critically ill babies, the problems related to use of a monovoxel sequence, the dispersion of the ratios and the lack of determination of the absolute concentration of the metabolites.
Therapy for asthma is being prescribed more frequently. However, asthma mortality remains high in many countries. Fatal outcome is not always related to inadequate follow-up. In this article we report that children with mild to moderate symptoms may present a fatal attack. Many factors are responsible for such an outcome: asphyxia +3 due to ventilation/perfusion mismatch and/or bronchospasm, cardiac failure, cardiac arrhythmia, intrinsic positive expiratory pressure, or metabolic disturbances (hypokalemia, for example). Such problems can occur in predisposed patients: it has been shown that the chemosensitivity to hypoxia and the perception of dyspnoea are altered in certain patients with near-fatal asthma. It is very important to identify children at risk of severe asthma and to organize care so as to optimize the management of such children.
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Agrobacterium radiobacter was isolated from 15 blood cultures collected from 15 newborns. Contamination of blood cultures was suspected because, in most cases, the babies' illnesses seemed incompatible with infection. A radiobacter was isolated from citrated tubes used for clotting-factor studies. Review of venipuncture technique revealed that occasionally the coagulation study tubes were being inoculated before the blood-culture bottles. This investigation demonstrated how an environmental source coupled with faulty technique caused a cluster of false-positive blood cultures.