ABSTRACT
Hyperbilirubinemia is frequently encountered in neonatology. This disorder causes mucocutaneous jaundice, often transient and mild. It is due to the physiological characteristics of the newborn as hepatic immaturity and fragile red blood cells with polycythemia. Sometimes it reaches levels to much high that exceed the control capacity of the organism and thus causes kernicterus with severe neurological sequelae. This is an exhaustive retrospective study on a series of cases of newborn infants with hyperbilirubinemia and registered in the service of biochemistry. We have profiled the types, etiology and assessment of risk of kernicterus in order to better situate the ideal model that ensures optimal management of neonatal jaundice. The neonatal hyperbilirubinemia were all with unconjugated bilirubin. The majority of them were due to physiological origin, but the maternal-fetal blood incompatibility and neonatal infection are not negligible. All are likely to expose to serious neurological complications. Newborns, especially premature babies with jaundice of the integument must be screened for potentially severe jaundice. The prevention of alarming levels of bilirubin not bound to albumin must be realized through a monitoring including total bilirubin and albumin, or failing that, the serum protein. The best adaptation of albumin to bilirubin becomes possible by the prompt initiation of therapy, minimally invasive, such as phototherapy or the infusion of albumin. It is imperative to integrate this action in a global screening and to implement an algorithm taking into account all risk factors
ABSTRACT
Escherichia coli is the germ most frequently isolated in espicially urinary infections. The perpetual change of its sensitivity profile to beta-lactamins is [due to several evolution factors. Some strains have acquiered resistance by gene mutation or by acquisition of movable genetic material. Also phenomenon as impermeability, excretion by efflux system or modifying penicillin liaison proteins could be seen but the production of beta-lactamases remains the most frequent mechanism of resistance that has been describe until now. The authors report, through this observation, a case of a particular strain of Escherichia coli that has been isoleted from urine of an hospitalized patiente. This strain presented an hyperproduction of cefalosporinases, which is a recently discovered mechanism of resistance. In one hand, specific bacteriologic tests as synergy test, antagonism test and the use of cloxacillin added antibiogramme on Mueller-Hinton medium were carried out and have allowed to display the phenotypic aspect of this mechanism. In the other hand, its genetic aspect was mentionned through a new literature data. The authors have also underlined the importance of the antibiogramme prior to any prescription of antibiotics which could put pressure on the germ leading to a selection of individual resistant, to this kind of difficul not controlled resistance and many potential complications ensue from it