[Cardiogenic shock due to spontaneous neonatal thrombosis of the abdominal aorta]. / Choc cardiogénique dû à une thrombose spontanée néonatale de l'aorte abdominale.

Neonatal arterial thrombosis is unusual and generally associated with an arterial umbilical catheter. Spontaneous aortic thrombosis is exceptional but its severity is related to high mortality rate and renovascular morbidity. We report here the observation of a 10-day-old term infant showing a large abdominal aortic thrombosis revealed by cardiogenic shock induced by systemic arterial hypertension. The resolution was fast following anticoagulant and antihypertensive therapy. Etiologic investigations showed renal failure and moderate hyperhomocysteinemia controlled by a vitamin supplement. Following this observation, we did a brief review of the neonatal spontaneous arterial thrombosis literature to discuss the neonatal hemostasis specific aspects. Management of infants presenting an arterial thrombosis varies depending on the hospital and there are no guidelines at this time concerning the etiologic investigation and treatment in France or internationally.

[Memory boxes in the neonatal period: caregivers' opinions after 1 year of practice]. / Coffrets de souvenirs en réanimation néonatale et pédiatrique : ressenti des soignants un an après leur mise en place.

UNLABELLED: Perinatal death is a profound experience for childbearing families and mementoes are key to providing essential records of the baby's life and death. The aim of this observational study was to evaluate the caregiver's feelings on 1 year of using memory boxes in the neonatal and pediatric intensive care unit of a tertiary care center. METHOD: Anonymous survey containing 14 questions. RESULTS: During the study period, a memory box was made for 31 neonates (24 preterm and 7 term infants) and 4 infants. Thirty-nine (54%; 32/62 nurses; 7/12 physicians) answers were obtained. Caregivers considered that memory boxes: i) were appropriate for death in the neonatal period (80-92%) or for infants who had never returned home (80%), ii) helped parents in their grieving process (77%), and iii) helped caregivers to support parents respecting their spirituality and emotional needs (62%). Some restrictions were mentioned such as the symbolic impact of the box mimicking a coffin and the modeling clay used for footprints recalling children's toys (10%) and the possibility of hurting parents in their religious convictions (18%) or feelings (20%). For the majority of the caregivers, memory boxes were considered helpful for families (82%); a few thought they were helpful for the ICU team (26%). CONCLUSIONS: This is the first study describing caregivers' opinions about the memory box practices. Memory boxes are considered helpful for bereaved parents, especially in the neonatal period, but are of little help to the caregivers.

[Risk factors for developing pneumothorax in full-term neonates with respiratory distress]. / Détresse respiratoire du nouveau-né à terme : quels facteurs de risque de développer un pneumothorax ?

OBJECTIVES: To describe respiratory distress (RD) in full-term neonates hospitalized in the NICU and to determine risk factors in this population for pneumothorax. STUDY DESIGN: Retrospective inclusion for 4 years of full-term neonates hospitalized for RD before the 2nd day of life. Neonates were separated into Group I (RD with no pneumothorax) and Group II (RD with pneumothorax). Data collected from maternal and newborn medical records were obstetrical, perinatal, and postnatal. P<0.05 was set as the significance level. RESULTS: Ninety-six neonates were included. In this population, 64 (66.7%) were male, 45 (46.9%) were born by cesarean section, and 30 (31.3%) by elective cesarean section. Neonatal outcome was 4.6 days of hospital stay, 47.4% odds of mechanical ventilation, and 17.7% of persistent pulmonary hypertension of the neonate (PPHN). A central catheter was needed in 25% of the patients and amine treatment in 3.1%. The number of neonates born by cesarean section was lower as term increased. Those born by cesarean section were more likely to develop PPHN (26.7 vs 9.8%; P=0.03), and those born without labor were more likely to require oxygen (83.3 vs 63.6%; P=0.05). When comparing Group I and Group II (32 neonates), absence of labor (RR 1.5) and birth outside of a level III maternity unit (RR 1.6) were risk factors for pneumothorax. These results were confirmed in multivariate analysis. In Group II, birth before 39 weeks was a risk factor for bilateral pneumothorax (P=0.01). The median length of hospitalization was significantly longer in Group II than in Group I (5.8 days vs 4 days, P=0.03). CONCLUSIONS: RD at term exposes the infant to high morbidity and pneumothorax, especially if born outside of a level III maternity unit and absence of labor.

[Noninvasive mechanical ventilation in paediatric intensive care units: which indications in 2010?]. / Ventilation non invasive en réanimation pédiatrique : quelles indications en 2010 ?

Noninvasive ventilation (NVI) is increasingly used in paediatrics, although there is a high variety of practices and a paucity of published data in paediatrics. The last French consensus conference recognized a specific role of NVI for infants suffering from acute bronchiolitis with apnoea, and acute respiratory failure due to laryngotracheomalacia and cystic fibrosis. NVI is feasible and can be beneficial in paediatric acute respiratory failure during neuromuscular diseases. Like in adults, its place in other diseases such as acute bronchoalveolitis without apnoea, acute respiratory failure during neuromuscular diseases, status asthmaticus, acute respiratory distress syndrome (ARDS) and postextubation respiratory failure is growing, even though not always defined. All these adult recommendations have not been validated in the pediatric setting, and, thus, taking the paediatric characteristics into account is essential. In 2010, NVI had an important place in PICU, and must be managed by a trained team whose practice is regularly evaluated.

[Evaluation of the French neonatologists' attitude towards the birth of an infant at less than 26 weeks' gestation]. / Évaluation de l'attitude des néonatologues français face à la naissance d'un prématuré d'âge gestationnel inférieur à 26 semaines d'aménorrhée.

UNLABELLED: Resuscitation of infants who are born at the threshold of viability remains highly controversial. The purpose of our study was to evaluate the French neonatologists' attitude toward the birth of an infant at less than 26 weeks' gestation (WG). METHOD: This article reports the results of a survey sent by the Internet to one of the neonatologists in each of the NICUs in France. The answers showed the different attitudes at the time of the birth of an extremely premature infant born less than 26 WG. RESULTS: The respondents represented 57 % of the original sample. None resuscitates an infant born between 22 WG+0 days and 22 WG+6 days. During the 23rd WG, the majority answer (90 %) was "Resuscitation is never undertaken". During the 24th WG, the main answer (29 %) was "Resuscitation is undertaken if neonatal adaptation is sufficient". During the 25th WG, several answers were given, but only 6 % chose "Resuscitation is never undertaken". CONCLUSION: Analyzing the survey's answers indicates that the decision of whether to resuscitate these premature infants at the threshold of viability must be adjusted not only by gestational age, but also by many other factors.

[Interfaces for pediatric noninvasive ventilation (excluding neonate)]. / Interfaces pour la ventilation non invasive de l'enfant (à l'exclusion du nouveau-né).

The quality of noninvasive ventilation in pediatrics is interface-dependent. Several types of interfaces are currently available: nasal and oral masks, nasal pillows and helmets. Despite material improvements in material design, shape, size and components, interfaces are still not adapted for most children. The ideal interface must fit the child's characteristics and the disease requirements. For instance, a nasal canula is recommended for infants younger than 3 months of age. If necessary, nasal masks can be used as oronasal masks. Repeated and careful evaluations are indicated to ensure interface adequacy and to detect cutaneous injuries and facial deformities. Training is required for medical and paramedical personnel. Pediatrics studies, comparing interfaces, are needed to build evidence-based recommendations.

[Continuous two channel electroencephalography: description, applications, benefits and pitfalls]. / L'EEG d'amplitude: description, applications, avantages et inconvénients.

Children, term and preterm newborn care require electrophysiologic investigations for seizure detection and therapeutic management or prognosis purposes. Amplitude-integrated electroencephalography (aEEG) offers an accessible by non expert, bedside continuous cerebral monitoring. A 2 year utilization of aEEG in a neonatal and paediatric intensive care unit is described as advantages and as pitfalls. Technical description and aEEG classifications for interpretation only available for term newborn are described. To obtain a performing utilization (technical and interpretation) it was necessary to have about 1 year of training including medical and paramedical formations. Our experience shows that this easy-to-use technique requires a careful management, a trained and vigilant staff notably electrophysiologist to avoid inappropriate conclusions. Finally, aEEG is very efficient but in complement of standard EEG.

[Neonatal diagnosis of primary ciliary dyskinesia: report of one case]. / Dyskinésie ciliaire primitive à révélation néonatale: à propos d'une observation.

Primary ciliary dyskinesia is a rare, genetic disorder resulting of an abnormal ultrastructural morphology of cilia. Such disease is rarely recognized in neonatal period. We report on a newborn who exhibited unexplained respiratory distress. The diagnosis of primary ciliary dyskinesia was suggested by the association of bilateral and multiple atelectasis and situs inversus. Diagnosis was confirmed by three months of age by ultrastructural study of cilia. Primary ciliary dyskinesia is a rare disease. Diagnosis should be considered in unexplained cases of neonatal respiratory distress, especially when situs inversus totalis and multiple atelectasis are present. Diagnosis requires ciliary studies that can be performed in newborn infants.

Dose-finding study of ibuprofen in patent ductus arteriosus using the continual reassessment method.

OBJECTIVE: Intravenous ibuprofen (IBU) has been found to be as effective as indomethacin for the treatment of patent ductus arteriosus (PDA) in preterm infants and has been associated with fewer adverse effects in comparative phase III studies. The dose regimen used (10-5-5 mg/kg/day) was based on limited pharmacokinetic data and no phase II study was available to determine the optimal dose of IBU for this indication. The present study was designed to determine the minimum effective dose regimen (MEDR) of IBU (one course) required to close ductus arteriosus in preterm infants. METHOD: A double-blind dose-finding study was conducted using the continual reassessment method, a Bayesian sequential design. Two distinct target closure rates were initially chosen according to postmenstrual age (PMA) at birth: 80% in infants with a PMA of 27-29 weeks, and 50% in infants with a PMA < 27 weeks. Forty neonates (20 in each PMA group) with PDA were treated between days 3 and 5 of life. Four different dose regimens were tested: loading doses of 5, 10, 15 or 20 mg/kg, followed by two doses (1/2 loading dose) at 24-h intervals. Efficacy was evaluated by echocardiography 24 h after the third infusion. RESULTS: In infants with a PMA of 27-29 weeks, the estimated MEDR was 10-5-5 mg/kg with a final estimated probability of success of 77% (95% credibility interval: 56-92%). The 15-7.5-7.5 mg/kg dose regimen had a better estimated probability of success (88%, 95% credibility interval: 68-97%), but resulted in more minor renal adverse effects. In contrast, in infants with a PMA < 27 weeks, the estimated MEDR was 20-10-10 mg/kg with an estimated probability of success of 54.8% (95% credibility interval: 22-84%), whereas the conventional dose regimen resulted in a low estimated probability of success (30.6%, 95% credibility interval: 13-56%). In these infants, compared with those with a PMA of 27-29 weeks, minor renal adverse effects were more frequent from the 10-5-5 mg/kg/day dose regimen and did not appear to be clearly dose related. CONCLUSION: This study confirms that the currently recommended dose regimen (10-5-5 mg/kg) of IBU is associated with a high closure rate (80%) and few adverse effects in premature infants with a PMA of 27-29 weeks. The failure rate was much higher below 27 weeks. A higher dose regimen (20-10-10 mg/kg) might achieve a higher closure rate. However, tolerability and safety of this dose regimen should be assessed in a larger population before considering the use of these doses for ductus arteriosus closure.

[Retinopathy of prematurity screening and follow-up with Retcam120: expertise of a team of neonatologists concerning 145 patients]. / Dépistage et suivi de la rétinopathie du prématuré par caméra de rétine (Retcam 120) : expérience d'une équipe de néonatalogistes à propos de 145 cas.

OBJECTIVES: The high incidence of retinopathy in very premature infants requires strict evaluation and follow-up in neonatal intensive care. The strict organization required in each center, under the responsibility of ophthalmologists, is sometimes puzzling. Therefore, we tested the hypothesis that the introduction of the Retcam allows the neonatologist under the control of ophthalmologist to diagnose retinopathy of prematurity then preventing sequelae, by comparison of pictures interpretations between neonatologists and ophthalmologists. METHODS: The Retcam gives a 120 degrees picture of the retina which is captured digitally. Then, the interpretation of the neonatologist can be reviewed by the ophthalmologist. We screened premature babies less than 32 weeks of gestation and less than 1500 g, during 1 year, including learning experience. We compared pictures interpretation by neonatologists and ophthalmologists of Retcam recordings. RESULTS: One hundred and forty-five patients were included. Eight cases of retinopathy were diagnosed with an exact correlation : 3 grade III in zone 2 form plus disease, 1 stage III zone 2 unilateral, 1 stage II in zone 3, 2 stage II en zone 2, 1 grade I zone 3 on at least 5 h contiguous. We had neither false positive, nor false negative. Five infants were treated without significant sequelae. CONCLUSIONS: Retcam 120 allows an easy diagnosis and follow-up for the retinopathy of prematurity by the neonatologist. We advocate to spread Retcam to the wards where the screening of retinopathy is difficult for the ophthalmology department. As every case requiring therapy is diagnosed, prevention of severe visual handicap is completed. The cost of this apparatus is equivalent to the cost of the care for a congenital blindness.

Acquired aqueductal stenosis in preterm infants: an indication for neuroendoscopic third ventriculostomy.

OBJECT: The object of this study is to demonstrate the delayed occurrence of aqueductal stenosis in preterm infants who have suffered from intraventricular hemorrhage (IVH) and to try to explain the mechanisms of this stenosis. METHOD: From January 1996 to June 2002, 1,046 premature infants were admitted to our institution. Thirty-six neonates suffered from grade 3 or 4 intraventricular hemorrhage (Papile grading), of whom 16 died. Twenty patients survived and a ventriculoperitoneal shunt was inserted in 7 infants. Four patients underwent a neuroendoscopic third ventriculostomy. Follow-up was carried out, twice a month during the first 2 months and subsequently twice a year. CONCLUSION: In 2 children NTV was an effective treatment for hydrocephalus with an average follow-up of 29 months. The specific pattern concerning these patients is the long delay before obstructive hydrocephalus and the visualization of de novo obstruction with MRI. The biological explanation must be investigated.

[Cutaneous aplasia, non compaction of the left ventricle and severe cardiac arrhythmia: a new case of MLS syndrome (microphtalmia with linear skin defects)]. / Aplasie cutanée congénitale, défaut de compaction du ventricule gauche et troubles du rythme cardiaque graves : un nouveau cas de syndrome MLS (microphtalmia with linear skin defects).

A female neonate presented with cutaneous aplasia located to the face and the neck associated with a non compaction of the left ventricle leading to the diagnosis of MLS syndrome (microphtalmia with linear skin defects). The follow-up was complicated by life-threatening cardiac arrhythmia underlying prevention by an early diagnosis and adequate care. MLS syndrome and non compaction of myocardium are both located on X chromosome.

[Posterior fossa hemorrhage in newborns following vaccum extractor delivery]. / Hémorragie de la fosse postérieure chez le nouveau-né après naissance par ventouse.

AIM: To emphasize the risk of posterior fossa hemorrhage in newborns following vacuum extraction. PATIENTS AND METHODS: Over a period of 26 months (September 1996-December 1998), seven patients who underwent delivery with the vacuum extractor had symptoms of brain stem compression, related to posterior fossa hemorrhage. They were referred to the neonatal intensive care unit. Some parameters had been analyzed: gestational period, delivery circumstances, gestational age, parameters of newborn, indications of vacuum extraction and other paraclinical investigations (biological and radiological). RESULTS: Ultrasound scan revealed intracranial hemorrhage in five cases of seven; mean time of diagnosis was 10 hours of age. All patients presented symptoms of brain stem compression. Mean period of follow-up was 22 months: six of seven patients had a normal neurodevelopment. One patient had a cerebellar ataxia, another one a palsy of the IIIrd cranial nerve. CONCLUSION: Analyses of posterior fossa by ultrasound scan should be made for newborns delivered by vacuum extractor, especially if they had symptoms of brain stem compression.

[Acute carbon monoxide poisoning during pregnancy: 2 cases with different neonatal outcome]. / Intoxication aiguë au monoxyde de carbone pendant la grossesse: deux cas d'évolution néonatale différente.

We report two cases of moderate maternal poisoning during the third trimester. They underwent hyperbaric oxygen therapy at 2.5 atmospheres for 90 minutes and were delivered at term. In one case the newborn presented an antenatal ischemic cerebral lesion probably due to monoxide poisoning. Pathophysiology and treatment of such accidents are discussed.

[Recombinant human erythropoietin in premature infants. Evaluation of a one year experience]. / Erythropoïétine humaine recombinante chez le nouveau-né prématuré. Evaluation d'une année d'expérience.

UNLABELLED: Recently, recombinant human erythropoietin (rhEPO) has been claimed to diminish red blood cell transfusions in premature infants. After a year of experience, we investigated whether early rhEPO treatment would reduce the need for transfusion. PATIENTS AND METHODS: Fifty premature infants of gestational age < or = 32 weeks admitted to our NICU in 1997, received rhEPO 750 UI/kg/week from day 3 to 5 for six weeks. They were compared with 50 untreated controls admitted in 1996. RESULTS: The treatment and control groups did not differ for gestational age, weight at birth, CRIB score, and blood losses. We were not able to detect any difference in the number of transfused infants, and in the number of transfusions per infant until discharge. However, treated infants received significantly fewer transfusions per infant between day 16 and day 45 (0.42 +/- 0.67 vs. 0.8 +/- 0.99). Infants with a birth weight between 1,000-1,250 g received fewer transfusions in the EPO group. CONCLUSION: rhEPO treatment can be useful, but in association with other procedures: conservative transfusion criteria, minimization of phlebotomy losses and early iron supplementation.