[Esophageal pacing in children. 38 consecutive cases]. / La stimulation oesophagienne chez l'enfant. A propos de 38 cas consécutifs.

On the occasion of a preliminary series of 38 cases, the authors review the esophageal pacing technique and its main indications. On the therapeutic level, the esophageal lead may be successfully used to decrease supraventricular tachycardias due to reentry (typical or atypical flutter, reciprocating nodal tachycardia with or without WPW). As a means of investigation, esophageal pacing is overall useful to diagnose undocumented paroxysmal tachycardia fits (palpitations), to evaluate the refractory stage of an accessory pathway (WPW) or to assess the refractory stage of antiarrhythmia medications. This investigation may also be used to assess the sinusal function, the atrioventricular conduction (Wenckebach point) and the spontaneous rhythm of atrioventricular blocks after pacemaker insertion. Due to the technical improvements achieved, esophageal pacing may be used presently in pediatric units taking care of children with arrhythmias.

Passive total respiratory system compliance and gas exchange in newborns with hyaline membrane disease.

Passive total respiratory system compliance (CRS) and gas exchange measurements were performed in nine newborns during the course of hyaline membrane disease. None of the subjects presented bronchopulmonary dysplasia at follow-up investigations. Gestational age ranged from 29 to 37 weeks. CRS was measured by the multiple occlusion technique. Gas exchange parameters were the fraction of inspired oxygen concentration (FIO2) and the arterial/alveolar ratio for oxygen (a/AO2 ratio). In each subject four tests were performed: test 1 during the first day of life; test 2 during the second day of life; test 3 between the fourth and the seventh days of life; test 4 after extubation. CRS/BW (CRS normalized for body weight) was not statistically different at tests 1-3, but it significantly increased (P less than 0.001) between tests 3 and 4. FIO2 and a/AO2 ratio presented no statistical difference at tests 1-2 but several significant differences were noted thereafter: FIO2 decreased significantly (P less than 0.001) when results from tests 2 and 3 were tabulated. The a/AO2 ratio increased significantly between tests 2 and 3 (P less than 0.001), and a further significant increase (P less than 0.01) was also noted when results obtained during tests 3 and 4 were compared. A significant relationship existed during the evolution of the disease between CRS/BW and gas exchange parameters (FIO2 and a/AO2 ratio) (P less than 0.01), but gas exchange improved earlier than lung mechanics.

[Comparison of arterial and transcutaneous oxygen partial pressure in infants with bronchopulmonary dysplasia]. / Comparaison des pressions partielles artérielle et transcutanée en oxygène chez des nourrissons atteints de dysplasie bronchopulmonaire.

Transcutaneous PO2 (PTCO2) (Radiometer electrode heated to 44 degrees C) was compared to arterial PO2 (PaO2) in 19 infants with bronchopulmonary dysplasia: 12 infants were tested once, at the mean postnatal age of 14 weeks (range 4-43 weeks), the other 7 infants were studied longitudinally from 5 weeks (range 2-8 weeks) to 12 weeks (range 6-18 weeks) of postnatal age. The protocol was standardized: measurement during behavioral stage 1, using a peripheral arterial line. Twenty-eight comparisons between PTCO2 and PaO2 were obtained. PTCO2 was significantly related to PaO2 [PTCO2 (mmHg) = 0.81 PaO2 + 5.2, r = 0.73, p less than 0.01]. The mean difference PTCO2 - PaO2 was -7.2 mmHg (range: -34.5 to + 33); in the studied age range the PTCO2 - PaO2 was not significantly related to postnatal age (r = -0.24; p greater than 0.1).

[Clinical and anatomo-pathologic study of 59 cases of sudden infant death]. / Etude clinique et anatomo-pathologique de 59 cas de mort subite du nourrisson.

A proper organization has been set up at Antoine-Béclère's hospital in order to study the infants who died suddenly. Between July 1985 and July 1987, 69 cases (10 babies less than 1 week of age) were admitted. The purpose of this work was, for the 59 sudden deaths of infants aged more than 1 week (35 males, 24 females), to present the results of a definite protocol of investigation (past history, clinical examination, laboratory and pathological data) for determining either the etiology or the mechanism of these deaths. A thorough investigation was performed in 45/52 cases (no autopsy in 7 cases). A definite diagnosis was possible in 38/45: 13 viral infections, 5 gastro-esophageal reflux, 13 viral infections associated with reflux, 9 with an additional event (massive alimentary inhalation, slipping under blankets, major hyperthermia) to either a viral infection or a reflux, 1 cardiac malformation, 1 metabolic disorder, 2 accidents and 1 infanticide. With this protocol, 7/45 deaths remained unexplained. This medical approach of the problem of sudden deaths in infants is beneficial to the counselling of the parents and to the management of subsequent children.

[Intravenous-intramuscular bioequivalency of ceftriaxone in newborn infants]. / Etude de la bioéquivalence intraveineuse-intramusculaire de la ceftriaxone chez le nouveau-né.

In 6 neonates over 7 days of life, comparison of maximum and residual serum concentrations of ceftriaxone after intra-venous or intra-muscular administration showed the bio-equivalence of both ways. In both cases a single daily injection obtained bacterial serum levels on most of the strains responsible for secondary bacterial infections in neonates.

[Post-transfusion hemolysis in premature infants. Apropos of 8 cases of post-transfusion hemolysis in premature infants]. / Hémolyse transfusionnelle du prématuré. A propos de 8 cas d'hémolyse post-transfusionnelle chez des prématurés.

Accidents related to blood transfusion have become rare in neonates, due to the application of very strict rules. The 8 reported cases of post-transfusion hemolysis occurred in prematures less than 32 weeks gestational age. Signs consisted of hemoglobinuria and/or severe jaundice. In some patients exchange-transfusion had to be performed. Immuno-hematologic, bacteriologic and technical investigations did not show the etiology of these accidents. No similar clinical reports were found in the literature. Some authors suggest a mechanical origin.

[Maternal administration of indomethacin and neonatal tricuspid insufficiency]. / Administration maternelle d'indométacine et insuffisance tricuspide néonatale.

The authors report the case of a neonate who presented since birth with refractory hypoxemia, peripheral edemas, ascites and pleural effusions. The mother had been given indomethacin for the 10 preceding days, in order to avoid premature labour. Echocardiography showed a tricuspid valve dysfunction with important regurgitation in the neonate. Under symptomatic treatment, clinical symptoms disappeared within 10 days. Echocardiography was normal by age 3 months. The responsibility of administration of indomethacin to the mother is discussed.

[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.

[C-reactive protein and the diagnosis of neonatal infection. A retrospective study of 242 cases]. / C réactive protéine et diagnostic d'infection néonatale. Etude rétrospective de 242 dossiers.

Serum C Reactive Protein (CRP) levels were measured in 242 neonates in whom materno foetal infection were suspected. In the 68 neonates in whom infection was proven, CRP levels were greater than or equal to 10 mg/l in 46 cases (68%). In the 154 neonates who were not infected, CRP levels were less than 10 mg/l in 132 cases (86%). In the 20 not infected neonates with positive peripheral samples for the same organism, CRP levels were less than 10 mg/l in 20 cases (100%). From these data, sensibility and specificity of CRP test for neonatal infection were respectively 67.6% and 85.7%.

[Antenatal cerebral hemorrhage and fetomaternal platelet incompatibility]. / Hémorragie cérébrale anténatale et incompatibilité plaquettaire foeto-maternelle.

A case of neonatal porencephalia is reported. It was due to antenatal hemorrhage associated with severe thrombocytopenia. Hematologic investigations showed a feto-maternal platelet incompatibility in the PLA1 system.

[A study of the perfusion of the ventilated alveolar areas in hyaline membrane disease]. / Estimation de la perfusion des territoires alvéolaires ventilés au cours de la maladie des membranes hyalines.

Thirty-three neonates presenting with hyaline membrane disease were investigated with simultaneous measurements of PACO2 and PaCO2, in order to establish the percentage (q) of the ventilated alveolar areas with little or no perfusion. Results show that during the acute phase of the disease, mean values for q are 40%. Highest figures are related with the most severe distress. In such cases, major pulmonary hypoperfusion is associated with extrapulmonary right to left shunts, as shown by a PO2 gradient between a pulmonary vein and the aorta. Later on, q values improve progressively. The importance of the reduction of the perfusion of the ventilated alveolar areas and its hemodynamic consequences suggest that in severe cases with hyaline membrane disease a pulmonary vasodilatator treatment could be prescribed, before the stage of refractory hypoxemia.