[Use of therapeutic hypothermia in sudden unexpected postnatal collapse]. / Malaise grave inopiné du nouveau-né à terme : une place possible pour l'hypothermie thérapeutique.

Sudden postnatal collapse of a full-term newborn is uncommon but may result in severe consequences: these include death; epilepsy; and motor, cognitive, or sensory impairment. Most authors suggest applying a therapeutic hypothermia approach when a previously healthy newborn develops moderate or severe encephalopathy after a sudden postnatal collapse occurring within the first hours or days after birth. However, this technique has still not been validated by randomized trials. Only a few cases have been reported in the literature. This article describes five apparently healthy newborns, born between 2007 and 2012, who suffered moderate to severe encephalopathy following a postnatal collapse on their first day of life. It describes their clinical history as well as their treatment and follow-up. The article focuses on the implementation of hypothermia in this indication and its limitations. Two newborns underwent classic therapeutic hypothermia, two others underwent temperature regulation (one at 34.5 °C, the other one for only 15 h because she quickly improved). One newborn, with severe pulmonary arterial hypertension, did not receive therapeutic hypothermia. Two newborns died (one had classic hypothermia and the other hypothermia at 34.5 °C), the outcome of the three survivors at three years, 18 months, and 15 months is good with only transient postural anomalies. Follow-up must be continued to assess their cognitive development and particularly their memorization processes. Additional research and centralization of the cases is required to evaluate the feasibility, safety, and benefits of therapeutic hypothermia in this situation.

Carbohydrate intolerance in infants with diarrhea.

PIP: Hospitalized infants suffering from acute diarrhea were used to test simple bedside methods of determining reducing substances and pH in multiple fresh stool specimens. 332 infants were tested, and thetests were useful in detecting a reduced capacity to tolerate lactose in 77% of these patients. Lactose intolerance was considered to be present when the stools had a carbohydrate content greater than .25% and/or a pH of less than 6. 75 of 77 lactose-tolerant patients recovered within 3 weeks of administration of a milk formula, whereas 111 of 195 with mild intolerance and 13 of 60 with severe lactose intolerance recovered while receiving the milk formula. Diarrhea of greater than 3 weeks duration occurred in 27% of those cases with mild and in with untreated severe intolerance; however, with prompt dietary treatment, a 62% of those cases favorable response always occurred. Lactose intolerance was positively correlated with increased severity of malnutrition; there were no correlations with previous episodes of gastroenteritis, with presence of enteropathogens or with associated infections. When antibiotic therapy was instituted, the stool pH increased toward alkaline, but the excretion of carbohydrates was not modified.^ieng