[Severe nutritional deficiencies in young infants with inappropriate plant milk consumption]. / Conséquences nutritionnelles de l'utilisation de boissons végétales inadaptées chez les nourrissons de moins d'un an.

Over the past few years, we have observed increasing consumption of inappropriate plant milks as an alternative to infant milk formula. Some families believe that foods labeled as natural are the most healthy and an appropriate nutritional choice. However, their composition does not respect European recommendations. They are always hypocaloric and protein, vitamin, and mineral concentrations are inadequate. The aim of this study was to report severe nutritional complications after inappropriate plant milk consumption. Between 2008 and 2011, we studied severe nutritional deficiencies caused by consumption of plant milks bought in health food stores or online shops. Infants were identified in our centers and examined through medical history, physical examination, and laboratory testing. Nine cases of infants aged from 4 to 14 months were observed. In all cases, these milks were used as an alternative to milk formulas for supposed cow's milk allergy. At diagnosis, four patients were aged 6 months or less. They had received plant milk exclusively for 1-3 months. The beverages consumed were rice, soya, almond and sweet chestnut milks. In three cases, infants presented severe protein-calorie malnutrition with substantial hypoalbuminemia (<20 g/L) and diffuse edema. In the other cases, the nutritional disorders were revealed by a refractory status epilepticus related to severe hypocalcemia (one case), growth arrest of both height and weight secondary to insufficient caloric intake (five cases), and severe cutaneous involvement (one case). Five children had severe iron deficiency anemia (<70 g/L), three children had a very low 25-hydroxy vitamin D level (nutritional rickets), and two had severe hyponatremia (<130 mmoL/L). Milk alternative beverages expose infants to severe nutritional deficiencies. Serious complications can occur. Early, exclusive, and extended use is riskier. These diseases are preventable, and parental education should be provided. Statutory measures forbidding their use in young infants should be organized to slow down the progress of this social trend.

Investigation of patient contacts of heath care workers with infectious tuberculosis: 6 cases in the Paris area.

SETTING: From June to October 2003, six cases of infectious tuberculosis were reported in health care workers (HCWs) working in hospitals in the Paris area. OBJECTIVE: To describe a method of investigation to identify tuberculosis infection in patient contacts. DESIGN: To define the cohort of patient contacts, the risk of contamination was evaluated based on 1) the degree of infectiousness of the HCW, 2) patient characteristics, and 3) the proximity and length of exposure. RESULTS: The number of patient contacts selected was very variable. A small proportion was investigated in consultation, except for a paediatric service in which 43 patient contacts were identified and where the information was managed within the service. In this cohort, two patient contacts presented tuberculous infection with an unclear link with the infectious HCW. In adults, the analysis of the information gathered was difficult due to the different screening practices used. CONCLUSION: These results show the importance of better targeting screening of patient contacts and of improving the detection of tuberculosis cases among HCWs.

[Evaluation of peri-intraventricular hemorrhages in newborn infants taking into account laterality and parenchymal location. Application to 323 consecutive cases]. / Cotation des hémorragies péri-intraventriculaires (HPIV) du nouveau-né avec prise en compte de la latéralité et de la localisation parenchymateuse. Application à 323 cas consécutifs.

An abbreviated scoring system for PIVH was derived from Papile's one: completed by a 0 for normal pattern, abcd divisions of each cerebral hemisphere for localization of parenchymal haemorrhages, and scoring of each side separately. The scoring system was applied to a consecutive series of 323 PIVH (1981-1984). Unilateral haemorrhages (123) accounted for 38% of all PIVH; they were almost exclusively grade I and II, and more frequently left-sided: 90 left and 33 right H. Of 200 bilateral haemorrhages, 127 were of equal severity on both sides, but left H. were more severe than right ones in 46/73 asymmetrical bilateral H. The survival rate was 91% in overall grade I H., 84% in overall grade II H., with little difference between uni- and bilateral H., 43% in overall grade III H. (34% in bilateral grade III), 28% in overall grade IV H. (1/11 in bilateral grade IV H). The extent of parenchymal H. only bore a partial relationship to the severity of the associated SEH-IVH, only half of the parenchymal haemorrhages being associated with grade III IVH on the same side, and only half of the unilateral PH being associated with a more severe SEH-IVH on the same side. The various former scoring systems have been reviewed. The interest of assessing both cerebral hemispheres separately and of evaluating the extent and location of PH is stressed.