Cerebrospinal fluid volume in neonates undergoing spinal anaesthesia: a descriptive magnetic resonance imaging study.

BACKGROUND: Spinal anaesthesia (SA) reduces the risk of postoperative apnoea after general anaesthesia in neonates. In 30% of patients, however, the duration of anaesthesia provided does not allow completion of surgery. When compared with term infants, formerly preterm neonates experience a shorter duration of anaesthesia after SA. A difference in the cerebrospinal fluid (CSF) volume between those two populations could explain this difference, but this has never been investigated. The study was designed to evaluate the relationship between the spinal CSF volume and patient characteristics in neonates. METHODS: Sixty-seven neonates, aged 30-60 weeks postconception, were included in this study. Their spinal CSF volumes were calculated using magnetic resonance imaging, and these volumes were plotted individually against sex, term at birth, birth weight, current gestational age, civil age, and weight. Correlations between CSF volume and these variables were investigated. RESULTS: Fifty-four neonates completed the study. The CSF volume was found to be closely and linearly correlated with weight and postconceptional age. The relationship between spinal CSF volume and weight can be described as follows: CSF volume (ml)=1.94 weight (kg)+0.13. The CSF volume was not correlated with sex, weight, or term at birth, nor with civil age. CONCLUSIONS: The amount of spinal CSF in neonates can be estimated as 2 ml kg(-1) in both term and formerly preterm neonates. A difference in the CSF volume between them does not provide an explanation for a shorter duration of SA in the latter. Our findings reinforce weight-adjusted dosage of SA in neonates.

Complications after conservative treatment of blunt liver trauma in children.

BACKGROUND: Nonoperative treatment is the gold standard approach to treat blunt liver trauma (BLT) in hemodynamically stable children. The purpose of this study was to evaluate the incidence, risk factors, timing for appearance, diagnostic modalities, management and outcome of hepatic complications secondary to such approach. METHODS: This retrospective study included children admitted at Montpellier University Hospital for BLT over a 10-year period. All hemodynamically stable children were initially conservatively treated. RESULTS: A total of 51 children underwent nonoperative treatment for BLT during the study period. The success rate was 94.1% (48/51). Three patients (5.9%) presented 13 complications related to hepatic injuries and required secondary surgical treatment. These 3 patients presented grade 3 or higher liver lesions. Others factors identified as predictive of complications included initial hemodynamic instability (responding to the first resuscitative measures), presence of peritoneal irritation at first examination, severe hemoperitoneum, an initially low haemoglobin level (< 8.5 g/dl) and need for important transfusions during the first 48h (> 10 cc/kg). The median interval for appearance of complications was 19 days after injury (range 1-60 days). Complications were successfully treated using minimally invasive techniques in 69.2% of cases (9/13). The rest of the complications (30.8% : 4/13) were surgically treated. All children included in our study had favourable outcomes (follow-up 1-54 months). CONCLUSIONS: This series fully validates conservative approach of BLT in hemodynamically stable children. Complications of such approach are uncommon; many can be successfully treated using minimally invasive techniques with very satisfying results.

[Ultrasound of the neonatal hip: initial evaluation and follow-up]. / Échographie de la hanche néonatale : bilan initial et suivi thérapeutique.

Developmental dysplasia of the hip can arise in utero due to a dislocating posture, sometimes associated with predisposing genetic factors. The ideal time for diagnosis is during the neonatal period and adequate screening procedures must be in place. Indeed, the plasticity of hyaline cartilage and fibrocartilage combined with the growth potential at this age nearly always result in rapid complete resolution of the deformity. Ultrasound, when indicated, is the best imaging modality for diagnostic confirmation. It allows evaluation of the osteocartilaginous structures, joint space and soft tissues. Ultrasound provides the clinician with a reliable morphologic and dynamic evaluation tool improving the diagnostic accuracy and guiding orthopedic treatment. Our experience, dating back to 1985, is based on a population imaged between 2007 and 2009. From a total of 2480 neonates screened because of abnormal finding or risk factors, we identified 257 cases of dislocation (10%) in 191 neonates : 14 cases of nonreducible dislocation (10 neonates), 30 cases of reducible hip dislocation (24 neonates), 97 cases of dislocatable hip (73 neonates) and 116 cases of subluxable hip (84 neonates). Clinical and sonographic follow-up demonstrated therapeutic success in 237 cases (93%) and failure in 20 cases (one case of subluxable hip, two cases of dislocatable hip, three cases of dislocated hip, 14 cases of nonreducible hip dislocation). Imaging follow-up (6 to 24 months) showed asymmetry in the size of the proximal femoral epiphyses in 20 cases (with resolution in 10 cases), three cases of dysplasia and one case of post-reduction osteochondritis.

[Fusobacterium necrophorum meningitis: forgotten complication of a gingivitis]. / Méningite à Fusobacterium necrophorum: complication oubliée d'une gingivite.

UNLABELLED: By now Lemierre's syndrome is a seldom-described disease whose prognosis depends on the precocity of treatment. CASE PRESENTATION: We report the case of an 11-month-old child, with a fulminant Fusobacterium necrophorum meningitis, which derived from a gingival infection, with fatal outcome. CONCLUSION: This atypical case of Lemierre's syndrome (young age occurrence and localisation) underlines the potential severity of F. necrophorum sepsis.

[MRI of fetal GI tract]. / IRM du tube digestif foetal.

The fetal diagnosis of GI tract abnormalities may be improved by the use of MRI that is able to visualize the normal bowel, may characterize the nature and location of gastrointestinal abnormalities, detect severe malformations, demonstrate the bowel close to cystic or tumoral intra abdominal structures. Our personal experience and recent data of the literature are reported.

Sonographic diagnosis of colitis in children.

To assist the radiologist in differentiating the colitis in children, this review proposes a systematic US approach to the disease, presents the US aspect of the normal colon and describes three distinctive US patterns reflecting the intramural extension of the histopathological changes. Each pattern corresponds to one or several diseases producing alterations in the same layer(s). Stratified thickening suggests an inflammatory mucosal process resulting from infection (as in advanced appendicitis or in infectious colitis) or to inflammation (as in IBD). Nonstratified thickening with loss of the haustral folds reflects a marked submucosal infiltrate. Color Doppler is required to distinguish between an inflammatory disease (as advanced CD or neutropenic colitis) and an ischemic colitis (HUS in children). Nonstratified thickening with preservation of the length of the haustral folds is the sign of an intraluminal deposit due to PMC. Correlating the sonographic pattern and the anatomic distribution of the disease with the clinical and laboratory findings often permits to propose a specific diagnosis.

MRI of fetal GI tract abnormalities.

We describe the magnetic resonance (MR) patterns of a variety of fetal gastrointestinal (GI) abnormalities. Thirty-two fetuses between 23 and 38 weeks' gestation with abnormal appearance of the GI tract by ultrasound underwent MR imaging with T1- and T2-weighted sequences. The MR aspect of intestinal atresia (duodenal atresia, one case; small bowel atresia, nine cases) included dilatation of the bowel loops, accurate assessment of the normal bowel distal to the atresia (except in the patient with multiple atresia and apple-peel syndrome), and micro-rectum with decreased T1 signal (except in the patient with duodenal atresia). Megacystis-microcolon-intestinal hypoperistalsis syndrome (one case) was indicated by an abnormal signal of the entire bowel and an abnormal pattern for the urinary tract. Meconium pseudocysts (two cases) were easily differentiated from enteric cysts (two cases). High anorectal malformations with (two cases) or without (one case) urinary fistula and cloacal malformation (one case) are described and MR findings are discussed. The capability of MR imaging to demonstrate the normal bowel with intraperitoneal anomalies (e.g., congenital diaphragmatic hernia, and sacrococcygeal teratoma) is emphasized. MR imaging is informative in the diagnosis of GI tract abnormalities, especially the severe malformations, with much more accuracy than sonography.

[Localized hypertrophic neuropathy (LHN) of the brachial plexus: diagnosis and presurgical evaluation with MRI]. / Neuropathie hypertrophique localisée (NHL) du plexus brachial: diagnostic et bilan préoperatoire par l'IRM.

The authors report a case of localized hypertrophic neuropathy diagnosed by MRI. This 10-year-old girl presented with painless progressive deltoid atrophy. Electrodiagnostic studies demonstrated chronic denervation. An MRI performed with T1, T2, T1 with gadolinium and fat saturation sequences showed a linear 5-cm long segment of hypertrophic brachial plexus cord, with moderate high T2, intermediate T1 signal, and marked post-Gadolinium enhancement. Progressive improvement followed surgical resection with nerve graft repair. Histological study confirmed LHN (perineurial cell proliferation), a rare cause of peripheral neurological deficit. MRI findings may suggest LHN, that should be suspected as well as peripheral nerve compression or tumor; inflammatory neuritis and idiopathic lesion (with normal MRI findings) remain a diagnosis of exclusion. MR aids in the precise localization of the lesion before surgery.

Advanced cranial ultrasound: transfontanellar Doppler imaging in neonates.

We know that many cerebral lesions are of circulatory origin and it is now important to study cerebral hemodynamics by pulsed and color Doppler ultrasonography. The revolution in the imaging of vascular physiology, the diagnosis, and the prognostic evaluation of vascular disease are not based on morphological sonographic studies but on the Doppler techniques that can display cerebral vessels in the neonate. The results of the hemodynamic investigation in 491 newborns aged from 32 weeks of gestation to 9 months by means of pulsed and color Doppler are reported. Normal values of the resistive index, peak systolic, end-diastolic, and time-averaged velocities in seven different vessels are determined. Some pathological examples are presented. Doppler techniques play a major role in the diagnosis, follow-up, and management of brain damage, whether ischemo-hemorrhagic, infectious, or developmental or tumoral, and of pericerebral collections.

[Brain sonography in 2001. Evaluation of macrocrania in the infant]. / L'échographie cérébrale en l'an 2001. Le point sur l'exploration d'une macrocrânie du nourrisson.

Transfontanelle sonography has become a routine imaging modality to assess infants with macrocrania: detection of hydrocephalus and diagnosis of its underlying etiology, detection and mapping of extra-axial collections, value of Doppler US for diagnosis of intracranial lesions, hemodynamic evaluation using pulsed Doppler imaging.