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S Leteurtre

Publications and source records attributed to S Leteurtre.

27 records · Page 2Linked to original sources
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

[Acute rhabdomyolysis in the child].

Rhabdomyolysis results from muscular fibre lysis with release of cellular contents (myoglobin, enzymes, electrolytes) into the plasma. Traumatic (crush syndrome) and non-traumatic rhabdomyolysis have been mostly reported in adults. Traumatic rhabdomyolysis are mostly due to ischemic and reperfusion injuries. Non-traumatic rhabdomyolysis include several factors: muscular compression (comas), cytotoxic injury (infections and poisonings), ischemia (shock, cardiorespiratory arrest) or excessive muscular activity (seizures, strenuous exercise). The main etiologies reported in children are: anoxic-ischemic encephalopathy (including sudden infant death and life threatening events); electrolyte disorders; severe hyperthermia; poisonings; hereditary myopathies. Non-traumatic rhabdomyolysis must be suspected in these circumstances, requiring blood creatinine phosphokinase measurements. Indeed, clinical signs are inconstant and non-specific, and functional signs are difficult to appreciate in children. During the initial phase, the main risk is arrhythmias secondary to hyperkalemia. The two main complications are the compartmental syndrome leading to irreversible vasculo-nervous injuries and acute renal failure. Treatment of traumatic and non-traumatic rhabdomyolysis includes correction of hyperkalemia, active fluid loading in order to prevent acute renal failure and alkalinisation. Prognosis of rhabdomyolysis relates to the aetiology and the presence of acute renal failure.

Acute Kidney Injury↗
PubMed1998

No resuscitation orders and withdrawal of therapy in French paediatric intensive care units. Groupe Francophone de Réanimation et d'Urgences Pédiatriques.

OBJECTIVE: To determine the incidence of different modes of death in French paediatric intensive care units and to compare patients' characteristics, including a severity of illness score (Paediatric Risk of Mortality: PRISM score) and prior health status (Paediatric Overall Performance Category scale), according to the mode of death. DESIGN: A 4-month prospective cohort study. SETTING: Nine French multidisciplinary paediatric intensive care units. PATIENTS: All patients who died in PICUs, except premature babies. MAIN RESULTS: Among 712 admissions, 13% patients died. Brain death was declared in 20%, failure of cardiopulmonary resuscitation occurred in 26%, do-not-resuscitate status was identified in 27%, and withdrawal of supportive therapy was noted in 27%. The PRISM score and the baseline Paediatric Overall Performance Category were not different between the four groups. Brain-dead patients were older than those in whom a do-not-resuscitate order and withdrawal of therapy were made (median age 81 vs 7 and 4 months). CONCLUSIONS: Decisions to limit or to withdraw supportive care were made for a majority of patients dying in French paediatric intensive care units. Chronic health evaluation and severity of illness index are not sufficient to describe dead-patient populations.

Brain Death↗
PubMed1997

[Characteristics of patients and use of resource in French pediatric intensive care units. Le groupe francophone de Rèanimation et urgences pédiatriques].

UNLABELLED: Evaluation of case-mix and resource consumption in pediatric intensive care units (ICU) is required. AIMS: This study describes the patterns of pediatric ICU resource consumption, determines the impact of primary clinical characteristics (particularly severity of illness) on resource utilization, and analyses medical efficiency with the frequency of inappropriate stays in French pediatric ICU. METHODS: Prospective study in nine French volunteer multidisciplinary pediatric ICUs from December 1993 to April 1994. Premature neonates were excluded. Resource consumption was expressed using the Omega system and length of stay, from which total Omega per admission, and average daily Omega (total Omega/length of stay) were obtained. RESULTS: Seven hundred and twelve patients were eligible. Twenty-five percent were full-term neonates, 30% infants (1 month to 1 year), and 45% children. Surgical patients constituted 22% of the population. A chronic disease was present in 45% of infants and children. Immunodeficiency was present in 10% of patients. The median length of stay was 4 days (range: 1-155). The mean Omega scores per admission were: total Omega = 92 +/- 124, Omega/day = 14 +/- 9. Sixty-four percent required mechanical ventilation and 37% during more than 2 days. Forty-two percent had a central venous access, and 23% an arterial line. The resource consumption was greater in non-survivors, surgical patients, neonates, and immunosuppressed patients. The mean PRISM score was 9 +/- 9. Mortality was 13%. The Omega/day and the PRISM score correlated. The frequency of inappropriate stays was 7.6% and accounted for 1.0% of the overall Omega activity. CONCLUSIONS: The results of this study can be used for interinstitutional comparison and a broader appraisal of pediatric intensive care. They illustrate the relationship between severity of illness and resource consumption. French pediatric ICU efficiency seems to be high, as compared to North American and Dutch results.

Adolescent↗
PubMedDate not supplied

Development of a pediatric multiple organ dysfunction score: use of two strategies.

BACKGROUND: An organ dysfunction (OD) scoring system for critically ill children is not yet available, and the method for developing such a system is not well defined. The aim of this study was to compare two developmental methods for assessing OD in critically ill children. METHODS: Consecutive admissions between January and May 1997 in three French and Canadian pediatric intensive care units (PICUs) were studied prospectively. Physiologic data were selected using a Delphi method; the most abnormal values during PICU stay were recorded. The outcome measure was the vital status at PICU discharge. Six organ systems were studied: hepatic, cardiovascular, renal, hematologic, respiratory, and neurologic. For each of the six organ systems, the PEdiatric Multiple OD (PEMOD) system included one variable and the PEdiatric Logistic OD (PELOD) system included several variables. Severity levels and relative weights of ODs were determined according to the mortality rate (PEMOD) or by logistic regression (PELOD). RESULTS: There were 594 admissions, including 51 deaths (9%). Severity levels and relative weights of ODs were: four levels graded from 1 to 4 for the PEMOD system and three levels with scores of 1, 10, and 20 for PELOD system. For both systems, calibrations were good (p = 0.23 and p = 0.44 respectively). The PELOD system was more discriminant than the PEMOD system (areas under the ROC curves 0.98 and 0.92, respectively, p < 10(-5)). Moreover, with the PEMOD system, four ODs did not contribute significantly to the prediction of PICU outcome. CONCLUSIONS: The PELOD system was more discriminant and had the advantage of taking into account both the relative severities among ODs and the degree of severity of each OD.

Adolescent↗