[An rare complication of scarlet fever : invasive group A streptococcal infection with streptococcal toxic shock syndrome]. / Infection invasive à Streptocoque du groupe A dans le décours d'une scarlatine.

Invasive Group A Streptococcus infections and streptococcal toxic shock syndrome are rare complications of common diseases in children such as scarlet fever or impetigo. These invasive diseases are particulary challenging because of their rapid progression and the lack of predisposing factors in most cases. Prompt diagnosis and treatment are mandatory to reduce the mortality associated with these severe diseases. We report the case of an 8- year-old girl who developped an invasive group A streptococcal disease with osteomyelitis and streptococcal toxic shock syndrome in the course of a classical scarlet fever.

Les infections invasives à Streptocoque du groupe A et le syndrome de choc toxique streptococcique sont des affections rares qui peuvent compliquer des infections communes de l'enfant telles que la scarlatine ou l'impetigo. La progression rapide de ces formes invasives et leur survenue, dans la majorité des cas, chez des enfants sans facteur de risque identifiable, les rend particulièrement redoutables. Un diagnostic et un traitement agressif précoces sont essentiels pour réduire la mortalité associée à ces affections graves. Nous rapportons le cas d'une enfant de 8 ans ayant présenté, dans le décours d'une scarlatine, une infection invasive à Streptocoque du groupe A avec ostéomyélite et syndrome de choc toxique streptococcique.

[Neonatal hyperthyroidism: clinical pattern and therapy]. / L'hyperthyroidie néonatale: clinique et prise en charge thérapeutique.

Neonatal hyperthyroidism is a rare pathology, most often the consequence of Graves' disease in the mother. Around 0.2% of pregnant women have Graves disease and 1 to 2% of newborns of mother with Graves' disease. This article will describe the case of 4 newborns who have been diagnosed and treated in CHU-NDB between 2007 and 2011. The second part will focus on the new recommendations about the management of these young patients from foetal period to birth.

Dual-energy X-ray absorptiometry in small subjects: influence of dual-energy X-ray equipment on assessment of mineralization and body composition in newborn piglets.

There is a growing body of literature that describes the use of dual-energy x-ray absorptiometry (DXA) for bone mineral content (BMC) and fat mass (FM) assessment in neonates, but the reproducibility and accuracy of the method are still controversial. Two different software programs have been developed for use on Hologic densitometers: the Pediatric Whole Body (PWB) and the Infant Whole Body (IWB) programs. They differ in scan time, radiation exposure, and in the algorithm used to assess BMC. We evaluated the reproducibility and accuracy of PWB and IWB in newborn piglets. Reproducibility of body mass (BM), FM, and BMC measurements from PWB and IWB were similar. BM agreed well with scale weight with both software programs; IWB was within +/- 0.5% and PWB was within +/- 0.3% of scale weight. FM was highly correlated with carcass fat (PWB: r = 0.962; IWB: r = 0.980). Errors in the DXA estimation of fat were similar with PWB and IWB. With both software programs, BMC was highly correlated with carcass calcium (PWB: r = 0.925, IWB: r = 0.987), but errors in the DXA estimation of calcium were about twice as high with PWB (+/- 16.9%) than with IWB (+/-9.2%). In four piglets, the addition of a layer of porcine lard was associated with an increase in BMC; this effect was more pronounced with PWB (+ 156%) than with IWB (+ 15%). The IWB software provided BMC measurements that were more precise, accurate, and stable in the presence of added fat than the measurements obtained with PWB, indicating that IWB is superior to PWB for in vivo determination of BMC and body composition.

Reference values of body composition obtained by dual energy X-ray absorptiometry in preterm and term neonates.

BACKGROUND: As previously reported, dual-energy x-ray absorptiometry provides reliable and accurate values for bone mineralization in piglets and infants, but overestimates fat content in small infants. The purpose of the current study was to determine an appropriate equation of correction for fat mass measurement and to establish reference values of body composition of preterm and term neonates. METHODS: Fat mass and chemical whole-body fat content were evaluated by dual-energy x-ray absorptiometry in eight piglets with a body weight between 1408 and 5151 g. The results were combined with previous data obtained in 13 piglets, and two correction equations were determined according to fat mass content. Close to birth, 106 healthy appropriate-for-gestational-age preterm and term infants were scanned by dual-energy x-ray absorptiometry to determine bone mineral content, bone area, and fat mass. Fat mass content determined by dual-energy x-ray absorptiometry was corrected using the equations obtained in piglets after which lean body mass was recalculated. RESULTS: Multivariate analysis showed that dual-energy x-ray absorptiometry body weight was the best predictor of bone mineral content (r2 = 0.94), bone area (r2 = 0.95), lean body mass (r2 = 0.98), and fat mass (r2 = 0.84). Gender was an additional significant independent variable for fat mass and lean body mass. Body weight related curves of percentiles for bone mineral content, bone area, fat mass, and lean body mass, were constructed. In vivo dual-energy x-ray absorptiometry values of fat mass and calcium content estimated from bone mineral content were in accordance with previously reported whole-body carcass reference values in preterm and term neonates. CONCLUSION: Normative data of dual-energy x-ray absorptiometry body composition for healthy preterm and term infants are provided and can therefore be used in research and in clinical practice.

Evaluation of dual-energy X-ray absorptiometry for body-composition assessment in piglets and term human neonates.

The reproducibility, accuracy, and precision of dual-energy X-ray absorptiometry (DXA) was assessed by scanning 13 piglets (1471-5507 g) in triplicate. In four piglets, fat content was increased with porcine lard around the abdomen; additional measurements were performed on these animals. Reproducibility in DXA measurements from the animals without added fat was 0.09% for body weight, 1.95% for bone mineral content (BMC), and 5.35% for fat content. DXA estimates of body weight, BMC, and fat content were significantly correlated with scale body weight, ash weight, chemical calcium, and chemical fat. Body weight was measured accurately but fat content was overestimated by DXA. Mean BMC estimated by DXA represented 48% of ash weight and 215% of calcium content. The precision of DXA was 0.23% for body weight, 10.99% for ash weight, and 4.44% for calcium content. The precision of DXA for fat content was poor. However, for measurements performed in piglets with > 250 g fat, the precision was 8.85%. Thirty appropriate-forgestational-age term human neonates (birth weight: 3188 +/- 217 g) were scanned once during the first week of life. BMC and fat content were 54 +/- 6 and 470 +/- 92 g, respectively, which corresponded to 26.4 +/- 2.6 g calcium and 427 +/- 82 g fat. These were close to the reference values previously determined by chemical analysis. This study suggests that DXA is accurate and reliable for measurement of calcium and fat contents in human neonates. Further refinements would be beneficial for determining fat content in preterm human infants.