[Evaluation of an educational intervention on the standard of neonatal resuscitation: orotracheal versus nasotracheal intubation]. / Quelle technique d'intubation enseigner dans un programme de formation à la réanimation en salle de naissance : voie orotrachéale ou nasotrachéale ?

UNLABELLED: Proficiency in endotracheal intubation is an essential step in the neonatal resuscitation process. This skill is difficult to acquire and its mastery requires experience. Recent changes in neonatal resuscitation guidelines (ILCOR 2006) have resulted in a decrease in the opportunities to practice intubations. Appropriate education and training is therefore essential. The goal of this study was to assess the skills of neonatal care professionals in performing intubation via orotracheal (OT) and nasotracheal (NT) routes. METHODS: OT and NT intubation attempts were compared during training on a neonatal mannequin (Laerdal, Neonatal Resuscitation Baby((R))) at each course of an educational intervention on neonatal resuscitation organized in level 1-3 institutions of the Maternités en Yvelines Perinatal Network. The duration of these attempts was noted; intubation in less than 30s was considered successful. RESULTS: Thirty-two midwifery students (STD), 103 midwives (MW) and 25 pediatricians (PED) participated in the study. The median (IQR) time for intubation was less with the OT route than with the NT route for STD (12.0 vs 23.0s; p=0.001), MW (14.0 vs 25.0s; p=0.001), and PEDs (13.0 vs 20.0s; p=0.007). The success rates for intubation in less than 30s were higher for the OT than the NT routes for STD (100% vs 66%; p=0.001), MW (97% vs 69%; p=0.001) and PED (92% vs 88%; p=NS). CONCLUSION: This study confirms that OT intubation training resulted in a higher success rate and lower duration for intubation. Practical courses in neonatal resuscitation should include training with OT intubation.

[Imported malaria in children in France]. / Paludisme d'importation de l'enfant en France.

UNLABELLED: Among the European countries, France is the most affected by imported malaria. The aim of this study was to take stock of the situation of imported malaria in children in France. METHODS: Attacks of malaria in children less than 15-year-old which have been notified to Centre National de Référence des Maladies d'Importation (CNRMI) were reviewed retrospectively between 1995 and 1997 and 1995 and 1998 for severe malaria. RESULTS: Over a period of 3 years, 1256 malaria attacks were notified in children including 90.9% without signs of severity. The mean age was 7 years. Sex ratio was 1.19. About 44.5% were French. Most of the cases were acquired in Africa. Plasmodium falciparum was involved in 79.2% of the cases. About 61.8% of children have been under prophylaxis but only 37.9% admit good compliance. Chemoprophylaxis was frequently inadequate. Halofantrine was prescribed for 76% of these children. Over a 4-year period, 51 children were notified as severe malaria attacks. Among them, 17 had severe malaria as defined by the World Health Organisation criteria. Most of these patients (73%) were treated by quinine by intravenous route. Two children died. CONCLUSION: Paediatric malaria is not rare in France. Only the improvement of prophylaxis could decrease the incidence of malaria in France.

Low levels of pancreatic elastase 1 in stools of preterm infants.

The amount of faecal pancreatic enzyme elastase 1 was significantly lower in 42 preterm newborns than in 12 full term babies at day 2 (89 (3-539) v 354 (52-600) microg/g, p<0.0007) and day 5 (164 (3-600) v 600 (158-600) microg/g, p<0.05) and correlated positively with total nutrient intake during the first week of life in preterm infants. This should probably be taken into account during early feeding.

[Prion diseases in pediatrics]. / Les maladies à prions en pédiatrie.

Prion diseases are rare neurologic affections with a poor prognosis, occurring in both humans and animals. Creutzfeldt-Jakob disease (CJD) secondary to human extracted growth hormone treatment is the most frequent condition in pediatrics. In 1994, a new type of CJD (variant CJD) was described in young adults in the United Kingdom, only 10 years after the bovine spongiform encephalopathy epidemic, with recent works showing a direct relationship between the bovine epidemic and the human cases. An accumulation of a single protein called the prion protein (PrP) has been discovered in the brain in all of these cases, animal and human, leading to the hypothesis that a new infectious agent could proceed without any nuclear acid information; another hypothesis is that of a still unknown viral agent. The PRNP gene encoding for this PrP protein is well described: some mutations and a polymorphism in the 129th codon have been shown to be implicated in many cases of CJD. PrP is a ubiquitous protein, with yet unknown physiological function. There are still many questions to be answered: shall we expect new pediatric cases of variant CJD? Assuming that animal-human contamination is related to alimentation, are there other ways of contamination.