[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.

[Nosocomial Burkholderia cepacia outbreak in an intensive pediatric care unit]. / Epidémie nosocomiale à Burkholderia cepacia dans une unité de réanimation infantile.

BACKGROUND: We report an outbreak of Burkholderia cepacia respiratory tract infection and colonization in an intensive pediatric care unit.P PATIENTS AND METHODS: Between February and December 1999, B. cepacia was isolated from five children hospitalized in this unit. We reviewed the charts of the patients, evaluated the antiseptics use and the disinfection practices for reusable patient care equipment. An environmental study was conducted and comparison of B. cepacia was performed with genotypic method (RAPD). RESULTS: All patients were mechanically ventilated and had received large spectrum antibiotics. The disinfection procedure for reusable equipment was not respected and some single-dose of antiseptics solutions were used for several patients. B. cepacia was not found in 34 environmental samples. The RAPD assay revealed that all five isolates had identical DNA profiles. CONCLUSION: Despite the investigation the source of the B. cepacia clone in this nosocomial outbreak remained unknown, but antiseptics use and disinfection practices were revised. No new B. cepacia infections were identified after control measures were implemented.

[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.

[Diagnosis and treatment of multifocal neonatal hepatic abscesses using echography]. / Diagnostic et traitement d'une abcédation hépatique néo-natale multifocale par l'échographie.

An infant born of a diabetic mother at 36 weeks developed three liver abscesses consecutive to umbilical vein catheterization. After medical treatment, 2 abscesses were aspirated percutaneously under ultrasonic guidance. The child recovered rapidly.

[Endocardial fibroelastosis: prenatal manifestation of aortic valve stenosis]. / Fibroélastose de l'endocarde: manifestation anténatale du rétrécissement aortique orificiel. Diagnostic échographique.

A diagnosis of fibroelastosis was made in a 33-week-old fetus, based on the echocardiographic features of a marked impairment of left ventricular contractility and hyperechogenicity of the endocardium. Fibroelastosis was associated with an aortic stenosis. There was no evidence of hydrops fetalis. Prenatal detection of this severe congenital heart disease allowed its early management in an intensive care unit. Heart failure due to closure of the ductus required the use of prostaglandin, then a surgical aortic valvulotomy was performed. There was no postoperative problem, and one year after surgery the infant is doing well. His left ventricular contractility is normal, and echocardiographic features of fibroelastosis are no more present. Prenatal diagnosis, use of prostaglandin and increasing safety of neonatal cardiac surgery have improved the prognosis of this serious association.