[Pneumococcal conjugate vaccine coverage in a hospital center of the Metropolis of Lille in 2008]. / Couverture vaccinale par le vaccin pneumococcique heptavalent conjugué dans un centre hospitalier de la métropole lilloise en 2008.

OBJECTIVE: To describe the vaccine coverage of Prevenar(®), follow its evolution since its universal recommendation from 2006 and search the influence of certain socio-economic factors. METHOD: A prospective descriptive study by a questionnaire enrolled the first 250 children born after 2001 and aged more than 2 months admitted at our hospital emergency room with their health record. RESULTS: 77.11% of children from any age merged received the first dose of Prevenar(®); 89.51% of those less than 24 months versus 60.38% of those more than 24 months, p<0.0001. The follow-up by a paediatrician and the high mother educational level influenced positively the vaccination by Prevenar(®). CONCLUSION: Prevenar(®) vaccine coverage evolved well since its universal recommendation achieving a 89.51% rate for the first dose. The chase of a brought closer follow-up seems important to assess the impact of this new vaccine strategy.

[Familial use of ibuprofen in febrile children: a prospective study in the emergency room of an hospital in Lille]. / Utilisation familiale de l'ibuprofène chez l'enfant fébrile: une étude prospective aux urgences d'un hôpital lillois.

AIM OF THE STUDY: To assess the place of ibuprofen in the treatment of fever in children. PATIENTS AND METHODS: An anonymous self-questionnaire was submitted to the parents of 156 children aged less than 15 years and 3 months consulting for a fever in a pediatric emergency care unit. Questions related antipyretic drugs availability at home and their administration modality to the febrile child. RESULTS: Acetaminophen (liquid or rectal) was the first drug owned by families (N = 149, 96%). Ibuprofen was owned by 79 families (51%). The antipyretic drug administered as a first intention treatment was acetaminophen in 131 children (77%), ibuprofen in 27 (17%) and aspirin in 6 children (4%). An antipyretic bi-therapy was received by 58 children (35%), nearly always acetaminophen and ibuprofen (N = 48, 87%). The use of a bi-therapy was more frequent when ibuprofen was the first drug used. Children who received an antipyretic bi-therapy as compared to those who received a monotherapy exhibited significantly a higher fever level and long lasting fever period. Antipyretic drugs given to the sick children were prescribed by a physician in more than 90% of cases. CONCLUSION: Ibuprofen was largely used in febrile children. This drug has almost always been prescribed by a physician. However, due to its side effects, ibuprofen should be used only in high and badly tolerated fever that is not altered by a well conducted acetaminophen monotherapy.

[Subcutaneous fat necrosis in the newborn: a risk for severe hypercalcemia]. / Cytostéatonécrose néonatale: attention à l'hypercalcémie sévère.

Hypercalcemia associated with subcutaneous fat necrosis (SCN) is a well known but rare event in the newborn. A newborn infant with a history of SCN was admitted because of anorexia, adynamia, polyuria and polydipsia at 6 weeks of age. Serum calcium was markedly increased on admission, while it was normal on the first day of life. Evolution was favourable after treatment including isotonic saline solution, furosemide, corticosteroids, calcitonin and a low calcium and vitamin D diet. Hypercalcemia was severe enough to potentially induces fatal complications in this case. Neonates who develop skin lesions consistent with SCN should be followed-up for possible onset of hypercalcemia and treated in due time. The treatment of hypercalcemia in SCN is reviewed.

[Septic shock due to congenital disseminated toxoplasmosis?]. / Toxoplasmose congénitale disséminée responsable d'un choc septique?

Congenital toxoplasmosis secondary to maternal primary infection acquired late during pregnancy is generally asymptomatic at birth. We report a case of a newborn infant whose mother had been infected between the 27th and the 33rd week of gestation. No treatment had been given during gestation. The infant had a disseminated form of toxoplasmosis with hepatosplenomegaly, pneumonitis, purpura, hepatitis. On the third day of life, he developed shock. The patient died early despite therapy. Septic shock is unusual in congenital toxoplasmosis, although it has been described in immunocompromised patients, notably in patients infected with the human immunodeficiency virus.