[Epidemiology of nosocomial bacterial infection in a neonatal intensive care unit in Morocco]. / Épidémiologie de l'infection nosocomiale bactérienne dans un service de réanimation néonatale marocain.

In neonatal intensive care units, the incidence of nosocomial infection is high. This study aimed to determine the epidemiology of a nosocomial bacterial infection in the neonatal intensive care unit of Mohamed VI university hospital. A total of 702 newborns were included in this study. Of the 702 neonates studied, 91 had developed a nosocomial infection. The incidence rate was 13% and incidence density was 21.2 per 1000 patient-days. The types of infection were: bloodstream infections (89%), pneumonia (6.6%), meningitis (3.3%), and urinary tract infections (1.1%). Nosocomial infection was particularly frequent in cases of low birth weight, prematurity, young age at admission, umbilical venous catheter, and mechanical ventilation. Multiresistant bacteria included enterobacteria producing betalactamase (76.9%), especially enterobacteria that were dominated by Klebsiella pneumoniae (39.7%). The mortality rate was 52.7% in nosocomial infections, 19 (20.87%) of whom had septic shock. The results of this study show that nosocomial infection is an intrahospital health problem that could be remedied by a prevention strategy.

[Neonatal infection with Stenotrophomonas maltophilia (2 case studies)]. / L'infection néonatale à Sténotrophomonas maltophilia à propos de 2 cas.

INTRODUCTION: Stenotrophomonas maltophilia (S.M.) is a Gram-negative bacillus, naturally resistant to cephalosporins and carbapenems, which can colonize different sites and may be responsible for serious infections for which treatment is a real challenge. We report 2 cases of nosocomial S.M. infection in 2 hospitalized newborns in the neonatal intensive care unit. CASE 1: A 3-day-old newborn presented with infection beginning in the respiratory system, treated with ciprofloxacin, and complicated by septicemia, resulting in death. CASE 2: An 11-day-old newborn presented with brain S.M. suppuration: empyema and multiple abscesses were treated successfully with the combination of amikacin and chloramphenicol with good progression in the short and medium terms. DISCUSSION: Some epidemiological studies report that S.M. is the second Gram-negative bacillus responsible for nosocomial infection after Klebsiella pneumoniae. While the respiratory location of the bacterium is typical, cerebral parenchyma damage is rare in the newborn. The treatment remains very delicate and difficult because of this bacterium's drug multiresistance. CONCLUSION: These 2 cases of infection caused by S.M. including respiratory tract infection with bacteremia and cerebral suppuration in newborns have broadened the spectrum of diseases caused by this organism and are a reminder of the emergence of this organism and its natural resistance to several antibiotics.

[Isolated non-compaction of the right ventricular myocardium: two cases report]. / Non-compaction du ventricule droit : à propos de deux cas.

BACKGROUND: The noncompaction of myocardium is a rare myocardiopathy. The isolated right ventricular involvement is exceptional. We report two cases of isolated noncompaction of the right ventricular myocardium. CASE 1: I., 2 years old, investigated for a congenital cyanosis with severe functional repercussion. Her echocardiography revealed a complex congenital heart disease associated with isolate noncompaction of the right ventricle. CASE 2: A., 5 years old, was referred for history of syncope for the 2 last years. The echocardiography showed a severe pulmonary hypertension and an isolate noncompaction of the right ventricle. CONCLUSION: Due to the rarity of the isolate non-compaction of the right ventricle, it diagnosis remains difficult. The treatment and the outcomes of this disease are still unclear. An early diagnosis may help to reduce its complication.

Influence of socioeconomic status and body mass index on bone age.

BACKGROUND/AIMS: To evaluate the relationship of socioeconomic status (SES) and body mass index (BMI) with skeletal maturation in children from Marrakech (Morocco). METHODS: SES, BMI z-score and bone age (BA) were measured in a cohort of 623 children (280 boys and 343 girls, chronological age (CA) ranged from 6.6 to 18.8 years, mean 14.1 years). BA estimation was performed with the Greulich and Pyle atlas. Two social groups (privileged and unfavorable SES) were defined. A multiple linear regression analysis was performed to assess the relationship between BA-CA and age-and sex-specific BMI z-score. RESULTS: Global maturation delay was seen in the sample (BA-CA -0.56; SD 1.29). There was a significant relationship between skeletal maturation (BA-CA) and child BMI z-score among both genders. Bone age was more advanced in children with a greater BMI z-score. Privileged SES was positively associated with children's BA-CA for girls but there was no association for boys. In the boys' sample, there was no evidence that BA-CA variations with BMI z-score depended on socioeconomic status (p=0.664). Whatever the gender of the child, a greater BMI z-score increases the maturation. CONCLUSION: The multiple linear regression analysis is an interesting approach to understand the links between skeletal maturation, BMI and SES. In Moroccan children, excess weight is associated with privileged SES.

[Antiseptics in neonatology: the inheritance of the past in the daylight]. / Les antiseptiques en néonatologie : l'héritage des anciens à la lumière du jour.

The antiseptics are antimicrobial substances that are applied to living tissue to reduce the growth of microorganisms. The physiological particularities of newborns, and especially premature, reduce the list of used antiseptic in neonatology. The choice of antiseptic in neonates depends on its activity, its presentation and its tolerance. Using a large spectrum antiseptic like iodine and chlorhexidin seems to be the best choice; however the thyroid toxicity of iodine products contraindicates their use in the newborn. The usage of minor antiseptics like hexamidin shows no interest due to their limited spectrum and their long action delay. Using eosin for umbilical cord care is not recommended because it doesn't have any antiseptic activity and causes neonatal infections. Through this article, the authors review the principal aspects of antiseptic and report the properties and advantages-disadvantages of each antiseptic. The goal is to facilitate the choice of antiseptic used in neonatology.

[Pulmonary arteriovenous fistula: a rare cause of progressive asymptomatic cyanosis in neonates]. / Fistule artérioveineuse pulmonaire: une cause rare de cyanose progressive et muette chez le nourrisson.

A six month old girl with no significant medical history was admitted to hospital for progressive cyanosis of recent onset refractory to oxygen therapy. There were no detectable cardiac murmurs. Chest X-ray showed an irregular left posterior parahilar infiltration. Echocardiography showed dilatation of the left atrium and ventricle but no cardiac malformation. The diagnosis of pulmonary arteriovenous fistula was suspected. Chest CT scan, magnetic resonance imaging and pulmonary angiography demonstrated the arteriovenous fistula in the lower lobe of the left lung. It was much bigger than the appearances of the chest X-ray suggested. After the left lower lobectomy, the cyanosis completely disappeared. Progressive cyanosis refractory to oxygen therapy without any apparent cardiac or pulmonary disease is strongly suggestive of pulmonary arteriovenous fistula. Surgical treatment is curative whereas the spontaneous outcome of this condition may be lethal.