Management of meconium aspiration syndrome with highfrequency oscillatory ventilation.

BACKGROUND: 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. AIM: To evaluate the effectiveness of HFOV, used as the initial mode of ventilation, in neonates with severe meconium aspiration syndrome (MAS). METHODS: 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. RESULTS: 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. CONCLUSION: 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]. / Infection neonatale precoce a streptococcus pneumoniae: a propos de 3 observations.

BACKGROUND: S pneumoniae is a rare cause (1-8 %) of maternofetal infection causing an important morbi-mortality in the newborn and the mother. AIM: To report 3 cases of early neonatal infection due to S pneumonia. CASES REPORT: 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. CONCLUSION: Early neonatal infections caused by S pneumonia are rare and are an important cause of morbi-mortality in the newborn and the mother.

[Management of purpura fulminans apropos of 21 cases: diagnostic delay and therapeutic problems]. / Prise en charge du purpura fulminans a propos de 21 cas: retard diagnostique et problemes therapeutiques.

AIM: To evaluate the diagnostic delay and therapeutic insufficiencies delay before the transfer in ICU of the children admitted in the ICU of the children's hospital of Tunis with a purpura fulminans (PF). METHODS: A retrospective, descriptive study, of children with PF referred between January 2000 and January 2006 to a the paediatric intensive care unit (PICU) of the children's hospital of Tunis. The PF diagnosis was retained in any child presenting a feverish purpura and circulatory insufficiency signs. The optimal diagnostic and therapeutic charge taking was defined in three levels: parental, the first line doctors, and the hospital doctors. The symptoms' duration and the various treatments which were lavished to the patients were taken from the medical observations of the patients transferred in our PICU. RESULTS: Twenty one observations were collected. Twelve patients (57.1%) were addressed by a doctor exerting in a dispensary or by a free practicing doctor, 5 patients (23.8%) were transferred from a regional hospital and 4 children (19.1%) directly consulted the children hospital of Tunis urgencies delayed parental recognition occured in 11 children. The PF diagnosis was not evoked by the first line doctor in 62%. Eleven (52.4%) of the children with meningococcal disease were seen but not admitted by a doctor in the 48 hours before admission. Apart from 2 patients (9.5%) who were hospitalized in reanimation directly of the urgencies, all the other patients forwarded by a general pediatry service. In general pediatry, the PF diagnosis was not evoked in 3 cases (15.8%), 31.6% of patients had unnecessary a lumbar punctures and shock was not recognised or treated in 26.3%. Twelve patients (52.2%) died. The duration of hospitalization in general pediatry is significantly higher among deceased patients (5.5 +/- 6.6 hours) than among the surviving patients (2.6 +/- 1.5 hours); p < 0.05. CONCLUSION: Suboptimal treatement in PF is due to failure of parents, general practioners and hospital doctors to recognise specific features of the illness. Improvement in outcome could be achieved by public education and better training of clinicians in recognition, resuscitation, and stabilisation of seriously ill children.