[Fulminant pneumonia during varicella in an immunocompetent 16-month-old girl]. / Pneumopathie fulminante au cours de la varicelle chez une fillette de 16 mois immunocompétente.

Varicella is a cosmopolitan communicable disease caused by varicella-zoster virus (VZV) characterized by papulovesicular rash and fever. Management of fever and pruritus and prevention of bacterial infection are the main aspects of treatment. Severe complications and death may occur in pregnancy, in newborns, in adults, and in immunocompromised children. Contrary to immunocompetent adults in whom pneumonia occurs in 50% of cases during varicella, this complication in children is rare. We report a fatal case of pneumonia with severe hypoxemia during varicella in an immunocompetent 16-month-old child. Based on a literature review, we discuss the main aspects of diagnosis, treatment, and prognosis of varicella. Active immunization of children after 12 months of age is the primary prevention of varicella.

[Organization of patient management in level II centers in the Paris area: a prospective survey]. / Organisation de la prise en charge dans les centres de niveau II en région parisienne: enquête prospective.

Perinatal asphyxia is a common emergency for both obstetricians and pediatricians. A prospective study was conducted in 14 maternity hospitals (type II centres) in the Paris suburbs in order to assess pediatric activity and neonatal morbidity associated with supposed perinatal asphyxia in term newborns. Pediatricians were called in at birth very frequently: 1/20 deliveries. Intubation and/or resuscitation procedures were needed in 20% of cases and 20% of infants were referred to a neonatal unit for birth asphyxia or associated pathology. Moderate encephalopathy was observed in 1.5% of all term newborns who needed medical intervention for supposed birth asphyxia.

[Ethical dilemmas for end-of-life decisions in the perinatal period]. / Les dilemmes éthiques des décisions de fin de vie en période périnatale.

According to several recent surveys, around 50% of the deaths occurring nowadays in French neonatal intensive care units result from a medical decision. This has led French neonatologists to set up guidelines for end-of-life decisions and practice in the perinatal period, which are presented in this paper. It covers definitions, clinical situations, ethical principles, obligations of the medical and nursing staff.

[Ethical dilemmas in the perinatal period: guidelines for end-of-life decisions]. / Dilemmes éthiques de la période périnatale: recommandations pour les décisions de fin de vie.

According to several recent surveys, around 50% of the deaths occurring nowadays in French neonatal intensive care units result from a medical decision. This has led French neonatologists to set up guidelines for end-of-life decisions and practice in the perinatal period, which are presented in this paper. It covers definitions, clinical situations, ethical principles, obligations of the medical and nursing staff, and specific conditions where dilemmas occur.

[Withholding and withdrawing treatment in the perinatal period: importance of a coherent attitude between gyneco-obstetricians and pediatricians]. / Décisions de fin de vie dans la période périnatale: la cohérence obstétrico-pédiatrique est primordiale.

According to several recent surveys, 50% of deaths occurring in neonatal intensive care units in France occur subsequent to a medical decision. The French Neonatal Group therefore decided to publish guidelines for practice. These guidelines present: definitions, clinical situations, ethical principles, obligations of the medical and nursing staff, and specific conditions where dilemmas occur. These guidelines focus on the obstetrico-pediatrics relationship.

[Medical-social outcome of 59 infants born to addicted mothers]. / Devenir médico-social de 59 nouveau-nés de mère toxicomane.

BACKGROUND: Follow up of children born to drug-addicted mothers is difficult because of social context. The aim of this study was to determine the precise outcome in a cohort of infants from two neonatal units. POPULATION AND METHODS; Analysis of perinatal and follow up data of 59 infants born to drug-addicted mothers, admitted from 1988 to 1993 in the neonatal units of Colombes and Neuilly. RESULTS: Perinatal data: very poor social context; 100% addiction by opiates and very frequent polyintoxication; 21% HIV + mothers; 54% came later or not at all to prenatal care; 34% prematurity and 46% intrauterine growth retardation; 80% neonatal withdrawal symptoms. Precise follow up data is known for 95% of the infants at the age of 1 to 7 years: 5% died during the first year of life; 51% are living with their family (with or without their mother); 36% are in institutions or foster homes, and 8% are fully adopted; among 41 newborns discharged from neonatal unit to their mother, 34% have been secondarily placed by Child Protection Services. The only severe sequelae were not related to drug direct effect: 5 neurologic or respiratory chronic impairment related to prematurity, and 3 asymptomatic HIV + children; a few moderate behavioral problems appear to be related to social familial context. Among the 51 mothers, 6 died (5 by overdose) 19 are severely addicted, 10 have stopped addiction but 2 are HIV +, and 16 are lost to follow up. CONCLUSIONS: Analysis of this cohort and of the literature suggest a need for changing our perinatal strategies to ameliorate medico-psycho-social care of these pregnancies, mothers and infants, with or without methadone maintenance programs; these strategies have been proved to prevent perinatal problems (specially prematurity), and to improve mother-infant attachment.

[Chronic septic granulomatosis revealed by neonatal pulmonary aspergillosis]. / Granulomatose septique chronique révélée par une aspergillose pulmonaire néonatale.

BACKGROUND: Pulmonary aspergillosis is now the main cause of death in chronic granulomatous disease (CGD); it may occur before the age of one year and then often reveals CGD. CASE REPORT: A male newborn was referred to hospital at 27 days of age for fever (39 degrees C), hemodynamic failure and biological inflammation syndrome caused by pulmonary infection. Chest CT scan revealed multiple and bilateral intraparenchymatous nodules. An open lung biopsy showed histiocystic granuloma with multinucleated giant cells. Culture of tracheal, bronchoalveolar lavage samples and lung biopsy grew positive for Aspergillus fumigatus. Impaired chemiluminescence production by neutrophils was detected, enabling the diagnosis of CGD. It was later confirmed by the study of neutrophils functions. The child recovered after 12 months of parenteral amphotericin B therapy. CONCLUSION: A febrile multifocal pneumopathy occurring in infancy should lead to consider the possibility of CGD which may be confirmed by the chemiluminescence test.

[Asymptomatic placental Listeria infection]. / Placentite à Listeria asymptomatique.

A case of Listeria monocytogenes placental infection without foetal contamination is reported. The infant, normal at birth, developed progressive and severe neurological involvement. At 8 months of age, magnetic resonance imaging showed a bilateral cerebral atrophy. The responsibility of placental damage in altering the utero-placental blood flow with subsequent foetal hypoxia is discussed.

[Neonatal proteus mirabilis adrenal gland abscess]. / Abcès surrénalien néonatal à Proteus mirabilis.

The authors describe a case of unilateral adrenal abscess in a neonate, which was diagnosed at 13 days of age by abdominal ultrasonography. The newborn presented with persistent high white blood cells after Proteus mirabilis omphalitis. Magnetic resonance imaging and needle aspiration confirmed the diagnosis. This is the second case of Proteus mirabilis neonatal adrenal abscess reported in the literature. Percutaneous drainage allowed complete recovery.

[Kawasaki's disease with thrombocytopenia]. / Maladie de Kawasaki avec thrombopénie.

A thrombocytopenia has been observed at the initial stage of a mucocutaneous lymph node syndrome in a 8 year-old patient; it appeared at the 5th day of the disease in another 11 year-old patient. This unusual and unexplained transitory thrombocytopenia led to delayed administration of intravenous gammaglobulins.

Phosphatidylglycerol in tracheal aspirates for diagnosis of hyaline membrane disease.

Lecithin:sphingomyelin ratio and phosphatidylglycerol were determined by a rapid, simple method in tracheal aspirates obtained from 132 newborn infants with respiratory diseases, sixty five of whom developed hyaline membrane disease. Phosphatidylglycerol determination was more sensitive (97%) than lecithin:sphingomyelin ratio, but their specificities were similar (76%).

[Value of a rapid determination of phosphatidylglycerol in the endotracheal aspirate of the newborn infant in respiratory distress]. / Intérêt d'une détermination rapide du phosphatidylglycérol dans le liquide d'aspiration endo-trachéale chez le nouveau-né en détresse respiratoire.

An immunological method to measure phosphatidylglycerol (PG) levels was studied in 48 neonates with respiratory distress, by comparing the results with the lecithin sphingomyelin ratio (L/S) and with radioclinical data. In hyaline membrane disease (HMD), PG suggested immaturity in 91% of cases, as did L/S in 78%. In 6 of 20 cases with respiratory distress (30%) from other causes, PG level was low, which allows for discussion on the significance of this biological criterion as opposed to radiological and clinical criteria. This method of PG determination appears to be a more sensitive and reliable measure of lung maturity than the L/S ratio.

[Apnea disclosing Chlamydia trachomatis infection in a premature infant]. / Apnées révélatrices d'une infection à Chlamydia trachomatis chez un prématuré.

The authors report a peculiar type of maternofetal Chlamydia trachomatis (CT) infection in a 34 week-premature neonate. The revealing sign was the occurrence, at age 11 days, of frequent apneas with bradycardia, needing mechanical ventilation associated with adapted antibiotic therapy for 14 days. Diagnosis was confirmed by the isolation of CT in tracheal secretions. Immediate evolution was favorable. Literature data are reviewed and a short epidemiological survey is reported.

Intravenous immunoglobulin for neonatal isoimmune thrombocytopenia.

An infant with severe, isoimmune thrombocytopenia secondary to maternal anti-Pla 1 immunisation was treated successfully by intravenous gammaglobulin (400 mg/kg per day for five days). This treatment compared with Pla 1 negative platelet transfusions is discussed.