Management of meconium aspiration syndrome with high frequency oscillatory ventilation

High-frequency oscillatory ventilation [HFOV] has been advocated for use to improve lung inflation while potentially decreasing lung injury. There were few data on the early use of HFOV in hypoxemic term neonates. To evaluate the effectiveness of HFOV, used as the initial mode of ventilation, in neonates with severe meconium aspiration syndrome [MAS]. In a tertiary care paediatric intensive care unit, 17 term neonates with severe MAS were managed with HFOV, used as the initial mode of ventilation, and prospectively evaluated. Ventilator settings, blood gases, oxygenation index [OI] and alveolar-arterial oxygen difference [P[A-a]O2] were prospectively recorded during HFOV treatment and compared at the multiple time intervals. Target ventilation was easily achieved with HFOV. Initiation of HFOV caused a significant decrease in FIO2, achieved as early as 1 hour [from 0.93 +/- 0.11 to 0.78 +/- 0.25; p=0.031] and the improvement was sustained during the 1-32 hours period. There were a significant decreases in P [A-a] O2 and OI, respectively, at 4 hours [from 562.5 +/- 71.7 to 355.4 +/- 206 mm Hg; p=0.03] and 8 hours [from 23.3 +/- 17 to 14.6 +/- 16.3; p=0.04], that were sustained up to 16 and 40 hours. Three neonates [17.6%] developed pneumothorax on HFOV. One patient required oxygen support at 28 days. No significant others complications associated with HFOV were detected. Sixteen infants [94%] were successfully weaned from HFOV and 15 [88%] survived to hospital discharge. Use of HFOV as the initial mode of ventilation in neonates with severe MAS is an effective strategy

Early neonatal infection caused by Streptococcus pneumonias: report of 3 cases

S pneumoniae is a rare cause [1-8%] of maternofetal infection causing an important morbi-mortality in the newborn and the mother. To report 3 cases of early neonatal infection due to S pneumonia. Three cases of early neonatal infection due to S pneumoniae are reported. The three newborns were at term or near term babies with a vaginal delivery in two cases and a caesarean section in one case. They presented severe symptoms, with a progressive onset after birth, leading to hypoxemic pneumonia in one case and to septic shock in two newborns associated with meningitis in one case. S pneumoniae was isolated in the blood culture in two patients with positive soluble antigens in the cerebrospinal fluid in one case and positive peripheral bacteriological swabs in the other case. In the third case, S pneumoniae was isolated in the tracheal sample of the newborn and his mother. S pneumoniae was sensitive to ampicillin in two patients and of decreased sensitivity to ampicillin in one patient. The clinical course was favourable in the three patients after hospitalization in the intensive care unit. Early neonatal infections caused by S pneumonia are rare and are an important cause of morbi-mortality in the newborn and the mother

[Acute disseminated encephalomyelitis associated with mycoplasma pneumoniae infection in children 2 case report]

Extrapulmonary complications of Mycoplasma pneumoniae infection are rare and dominated by nervous system disorders. Two patients suffering from acute disseminated encephalomyelitis associated with M. Pneumoniae infection are reported. Report of two new cases the 2 cases, M. Pneumoniae infection was documented by the positivity of serology, polymerase chain reaction and culture in the respiratory tract. Patient I recovered after prolonged mechanical ventilation in the paediatric intensive care unit. He was fully conscious I month alter admission and able to walk with help 2.5 months after the onset of the disease. The 2nd patient died after 9 days of hospitalisation in the intensive care unit. The death was caused by neurovegetative disorders. Acute disseminated encephalomyelitis associated with Mycoplasma pneumoniae infection in children 2 case reports