[Effectiveness of chest physiotherapy in ventilated children with acute bronchiolitis]. / Efficacité de la kinésithérapie respiratoire chez des enfants intubés ventilés atteints de bronchiolite aiguë

OBJECTIVES: Despite the lack of clinical studies, chest physiotherapy (CP) is widely used in children with acute bronchiolitis. The main goal of this study was to evaluate its short-term efficacy in children under mechanical ventilation for acute bronchiolitis. METHODS: Twenty children were studied. All were under mechanical ventilation on a pressure-controlled mode. Oxygen saturation, transcutaneous PCO2 and tidal volume were measured before any intervention, after endotracheal suction, after CP and endotracheal suction and 1 h later. RESULTS: Thirty-eight analyses were performed. Baseline tidal volume, oxygen saturation and transcutaneous PCO2 were not modified after endotracheal suction. Immediately and 1 h after CP, SpO2 (98% vs. 94.5%), and tidal volume (66 vs. 55 ml) significantly increased. CONCLUSION: The increase of O2 saturation and tidal volume may be linked to the improvement of bronchial sputum clearance. Further studies are needed to estimate the long-term efficacy of CP in acute bronchiolitis.

Molecular cytogenetic analysis of a duplication Xp in a female with an abnormal phenotype and random X inactivation.

We describe a female infant with severe abnormal phenotype with a de novo partial duplication of the short arm of the X chromosome. Chromosome painting confirmed the origin of this X duplication. Molecular cytogenetic analysis with fluorescence in situ hybridization (FISH) was performed with YAC probes, further delineating the breakpoints. The karyotype was 46, X dup(X)(p11-p21.2). Cytogenetic replication studies showed that the normal and duplicated X chromosomes were randomly inactivated in lymphocytes. In most females with structurally abnormal X chromosomes, the abnormal chromosome is inactivated and they are phenotypically apparently normal relatives of phenotypically abnormal males having dupX. Therefore, in this case, there is functional disomy of Xp11-p21.2 in the cells with an active dup(X), most likely resulting in abnormal clinical findings in the patient.

[Neonatal hyperparathyroidism secondary to unknown maternal hypoparathyroidism]. / Hyperparathyroïdie néonatale secondaire à une hypoparathyroïdie maternelle méconnue.

UNLABELLED: Vitamin D or its analogue (calcitriol) is an effective treatment for hypoparathyroidism during pregnancy. Normal babies are delivered and very few cases of associated neonatal hyperparathyroidism are reported. CASE REPORT: We report the case of a baby born to a mother suffering unknown hypoparathyroidism. He was delivered prematurely by cesarean section for birth asphyxia. His mother had had recurrent bouts of impetigo herpetiformis for several months. Severe demineralization associated with decreased plasma calcium level were observed at birth. The PTH level was very high (955 ng/mL) in the baby and very low in the mother, leading to the diagnosis. The baby was given intravenous calcium gluconate, oral 1 alpha-hydroxyvitamin D and mechanical ventilation. Normal plasma calcium level was reached on day 2. PTH level improved by one month of age. Because of impaired respiratory mechanics and bronchopulmonary dysplasia, the baby was kept on ventilation for 58 days. By 20 months of age, he was in good health despite a small height for his age. CONCLUSION: In such cases 1 alpha-hydroxyvitamin D seems to be very effective but plasma and urinary calcium levels need careful monitoring.

[Spontaneous neonatal arterial thrombosis treated with tissue plasminogen activator]. / Thrombose artérielle néonatale spontanée traitée par activateur tissulaire du plasminogène.

BACKGROUND: Spontaneous neonatal arterial thrombosis is a rare entity with serious and potentially fatal complications. A wide spectrum of management has been proposed. CASE REPORT: Ophélie was born after premature delivery at 33 weeks. She was referred soon after birth in the neonatal intensive care unit for respiratory distress syndrome. Spontaneous acute ischemia of the right lower limb was noted soon after admission. Iliac thrombosis was confirmed by ultrasonography and colour coded doppler. Thrombolysis was achieved with systemic infusion of recombinant tissue plasminogen activator (rtPA). Full recovery was obtained within 12 hours of treatment without any complication. No rethrombosis occurred with heparin prophylaxis. No predisposing disorder to thrombosis was found. CONCLUSION: Systemic rtPA is an alternative to thrombectomy and urokinase in critically ill neonates. This treatment should be considered if no major risk of bleeding is found during the pretherapeutic screening.

[Bilirubin-albumin-binding function of 2 human albumin preparations (placental and plasma). Comparison of their efficacy in the icteric premature infant]. / Etude de la fonction de liaison bilirubine-albumine de deux préparations d'albumine humaine (placentaire et plasmatique). Leur efficacité comparée chez le prématuré ictérique.

Two albumin preparations obtained by Cohn fractionation of either plasma of blood donors (plasmatic albumin) or human placental blood (placental albumin) were studied in vitro and in vivo regarding their bilirubin-binding function. Analysis of this function during the industrial processing of the two preparations indicated that alcoholic fractionation and, to a lesser extent, stabilizers, were responsible for the decrease of (a) the association constants between albumin and bilirubin, (b) bilirubin-binding capacity of albumin. Unexpectedly, improvement of bilirubin-binding parameters was observed after the final heating stage. Stabilizers were reversibly bound as suggested by a further improvement of binding function seen after a brief contact of the preparations with red blood cells. The changes were similar for the two preparations. Fifty-one sick premature hyperbilirubinemic neonates were randomly infused either with placental or plasmatic albumin (1.5 g/kg). Albuminemia, bilirubinemia, erythrocytic bilirubin, unbound bilirubin (peroxidase method) were evaluated before and 3 hours after infusion. Improvement of bilirubin-binding parameters was frequently observed but without clear-cut relation with change in bilirubin/albumin molar ratio. No difference was noted between the two albumin preparations. In spite of a decrease of their association constants with bilirubin, the two albumins retained a high binding potency for bilirubin in vivo.

[Left diaphragmatic agenesis with digestive duplication and extra-lobar pulmonary sequestration (author's transl)]. / Agénésie diaphragmatique gauche avec duplication digestive et séquestration pulmonaire extra-lobaire.

The association of a diaphragmatic hernia and a pulmonary sequestration is known, though very rare. The authors present one singular observation because it were involved in aplasia of the homolateral pillar and a digestive duplication. They insist about the gravity of the reflux inherent to the malformation; they suggest its differed cure in spite of nutritional difficulties. Pathogenic considerations are advanced on that malformative complexe which is combined with the broncho-pulmonaries malformations of the foregut. It seems a direct proof of the theory of "the accessory lung". Finally, is underlined the gravity of the aplasia of the diaphragmatic leaf extensive to the pillar.

[The thyroid gland of the newborn infant and postnatal iodine overload]. / Thyroïde du nouveau-né et surcharge en iode après la naissance.

Severe iodine-induced hypothyroidism was recently diagnosed in several neonates raising the responsibility of the iodine antiseptic agents routinely used in these patients. Postnatal iodine overload due to cutaneous application of these agents (povidone iodine and fluorescinated alcoholic-iodine solution) was studied in 5 patients. Thyroid function studies were performed in iodine-overload neonates and in control neonates with comparable gestional age. Results indicated strong evidence of cutaneous absorption of iodine from the antiseptic agents used, leading to hypothyroidism in 12 of them. The frequency and the severity of thyroid dysfunction was closely related to the degree of prematurity. Full recovery was observed in all cases after withdrawal of the iodine-containing agents. It is therefore recommended to avoid any postnatal use of iodine preparations in neonates, mainly in preterm infants, and to use iodine antiseptic agents with great caution, when necessary during the neonatal period.

[Carbon monoxide poisoning of the fetus. Apropos of a clinico-pathological case]. / Intoxication oxycarbonée chez le foetus. A propos d'une observation anatomo-clinique.

Anatomical and clinical observations are described in a case of carbon monoxide poisoning which caused the death of the baby rapidly. The anatomical lesions are comparable to those observed in 8 other cases reported in the literature. The physiopathological mechanism involved is discussed in relation to previously reported clinical, toxicological, and experimental data.

[Severe bronchiolitis in the newborn (apropos of 13 cases)]. / Les bronchiolites sévères du nourrisson (à propos de 13 observations).

Bronchiolitis in newborns is a frequent infection, usually with a good prognosis. But there are also more severe forms, better known now, endangering the vital prognosis. The authors report the experience of an infant intensive care unit, where 13 cases of severe bronchiolitis were treated. After considering the etiological circumstances, they envisage the physio-pathological problems. Clinical and paraclinical signs are described. The authors particularly insist on the treatment of severe bronchiolitis using respiratory reanimation. In many cases, assisted ventilation with tracheal intubation helps to get over the worst part. Treatment of severe bronchiolitis remains today essentially symptomatic, but the practice of the appropriate treatment enables in most cases to cure the disease.

[Acute poisoning of an infant by cutaneous application of a local counterirritant and pulmonary antiseptic salve]. / Intoxication aiguë du nourrisson par application cutanée d'une pommade révulsive locale et antiseptique pulmonaire

The case of acute poisoning reported here raises the question of the harmlessness of preparations destined for cutaneous application in infants. After describing the method perfected for the identification and estimation of camphor, menthol and thymol in biological material, the authors present the toxicological, clinical and biological arguments in favour of the notion that the cutaneous resorption of these substances was responsible for this acute intoxication in an infant. Particular attention should be paid to poisoning which may result, in the newborn and infant, from the cutaneous application of active substances.