High-flow nasal cannula use for bronchiolitis treatment in French intensive care units: A transversal study.

Over the past 10 years, continuous positive airway pressure (CPAP) has revolutionized the prognosis and management of bronchiolitis patients hospitalized in pediatric intensive care units (PICUs). High-flow nasal cannula (HFNC) is emerging as an alternative to CPAP. Despite encouraging results of several clinical and physiological studies, HFNC use remains controversial and its indications heterogeneous. To better define the place of HFNC in severe bronchiolitis respiratory support, we investigated the different ventilation assistance techniques used for severe bronchiolitis over 3 days at the peak of a bronchiolitis epidemic in December 2015. We conducted an observational cross-sectional study in 27 French university hospital PICUs. Fifty-nine patients were included. The results show that HFNC already accounts for nearly half of the respiratory support techniques used for severe bronchiolitis in French PICUs with no significant difference between the CPAP group and the HFNC group of patients.

Sudden deaths in adult-worn baby carriers: 19 cases.

Soft infant carriers such as slings have become extremely popular in the west and are usually considered safe. We report 19 cases of sudden unexpected death in infancy (SUDI) linked to infant carrier. Most patients were healthy full-term babies less than 3 months of age, and suffocation was the most frequent cause of death. CONCLUSION: Infant carriers represent an underestimated cause of death by suffocation in neonates. WHAT IS KNOWN: • Sudden unexpected deaths in infancy linked to infant carrier have been only sparsely reported. WHAT IS NEW: • We report a series of 19 cases strongly suggesting age of less than 3 months as a risk factor and suffocation as the mechanism of death.

[Neonatal collapse: diagnosis of myocarditis]. / Défaillance cardiaque aiguë néonatale : diagnostiquer une myocardite avec certitude.

Enteroviruses are single-stranded RNA viruses of the picornavirus family. In the neonatal period, enterovirus can cause severe meningo-encephalitis, sepsis syndrome, hepatitis, or myocarditis. Neonatal enterovirus myocarditis remains a rare but severe cause of neonatal cardiac failure whose prognosis remains poor. Herein, we report the case of neonatal enterovirus myocarditis in a 14-day-old infant transferred to our intensive care unit for cardiogenic shock. Diagnosis and follow-up were confirmed using cardiac magnetic resonance imaging (MRI). We provide a detailed clinical, biological, and cardiac imaging description with specific comments on MRI diagnosis of myocarditis.

[Local salicylate transcutaneous absorption: an unrecognized risk of severe intoxication: a case report]. / Application cutanée localisée d'acide salicylique : un risque méconnu d'intoxication : à propos d'un cas.

INTRODUCTION: Although rare, salicylate intoxication through the skin should not be ignored as it can be severely life-threatening. We describe an original case of accidental poisoning with salicylates topically applied to the scalp of a 6-week-old infant. CLINICAL REPORT: A 6-week-old infant, with no prior history, was admitted to the pediatric intensive care unit for treatment of severe disorders of consciousness associated with significant tachypnea. Laboratory results revealed metabolic acidosis with elevated anion gap, ketonuria, and normal glycemia. Initial assessment ruled out the hypothesis of accidental ingestion of salicylates. However, the presence of salicylic acid derivatives in organic acid chromatography, confirmed by plasma salicylate levels at 580 mg/L, ultimately re-established the diagnosis. Further inquiry retrospectively highlighted the prolonged topical application in occlusion (3 days) of an extemporaneous preparation containing 23% salicylic acid on the scalp. The course after urine alkalinization was rapidly favorable without sequelae. COMMENT AND CONCLUSIONS: Salicylate intoxication is potentially lethal, particularly in infants under 12 months of age. The vast majority of these intoxications result from accidental ingestion. The present observation underscores the original and undescribed risk of intoxication due to a localized application to the scalp. In the presence of warning symptoms, salicylate poisoning should be investigated, including topical application of salicylic acid, even if localized. Careful attention should be paid to following the indications of use of this product in terms of concentration, characteristics of the infant, and exposed skin. The use of extended topical application of salicylic acid in concentrations greater than 3% should be avoided.

[Bronchiolitis among infants under 1 year of age in France: epidemiology and factors associated with mortality]. / Bronchiolite aiguë du nourrisson en France : bilan des cas hospitalisés en 2009 et facteurs de létalité

Little information is available on the characteristics of infants hospitalized for acute bronchiolitis in France. An analysis of hospital records (PMSI) was conducted at the national level to describe the cases of bronchiolitis that require hospitalization among infants under 1 year of age and the factors associated with death. The analysis of all admissions that occurred during 2009, for which the diagnosis of acute bronchiolitis was recorded in the PMSI database for infants aged less than 1 year, was performed. Cases were described according to age, sex, underlying conditions (including bronchopulmonary dysplasia, cystic fibrosis, and congenital heart disease), length of hospital stay, recurrent admissions, admission to an intensive care unit (ICU), and use of assisted ventilation. Factors associated with death during hospitalization were studied by logistic regression. The hospitalization rate was 35.8 per 1000 infants under 1 year in 2009 in France. Approximately 10% of hospitalized infants required ICU admission. Twenty-two infants died. The estimated case-fatality rate was 0.08% among hospitalized infants and 0.56% for those hospitalized in the ICU. Mortality among all infants under 1 year was 2.6/10(5) in France. Factors associated with death were bronchopulmonary dysplasia (OR=6.7, 95% CI [1.5-29.8]), hospitalization in an ICU (OR=6.46, 95% CI [2.4-17.4]), and the use of assisted ventilation (OR=6.2, 95% CI [2.2-17.1]). This study has enabled the quantification of the rate of hospitalization and mortality, and a better description of infants who need hospitalization. The results are consistent with international literature, but further prospective analysis will be needed to better describe the cases at higher risk, aiming to improve their management.

[Necrotizing community-acquired Staphylococcus aureus pneumonia]. / Pneumopathie aiguë nécrosante à Staphylocoque doré sécréteur de la toxine de Panton-Valentine.

Acute necrotizing pneumonia due to Panton-Valentine secreting Staphylococcus aureus was identified as a clinical entity by Gilet et al., in 2002. This severe acute necrotizing pneumonia occurring in previously healthy children and adolescents can lead to a rapid fatal outcome even if quickly diagnosed and treated. We report the case of a healthy 10-year-old girl presenting with hemorrhagic necrotizing pneumonia and septic shock. Bacteriological cultures yielded methicillin-susceptible Staphylococcus aureus. The course of the disease was characterized by recurrent uncontrolled hemoptysia leading to refractory hypoxemia. The details of the hospital stay are presented. We discuss the clinical features of the disease and describe recent epidemiologic data and Panton-Valentine toxin research results as well as primary hospital care and treatment.