The effects of mesenteric ischemia on ileal colonization, intestinal integrity, and bacterial translocation in newborn piglets.

The effects of mesenteric ischemia on ileal colonization, intestinal integrity, and bacterial translocation (BT) in newborn piglets were investigated in 362-day-old Pietrain piglets. Group I, controls were not operated upon; group II underwent a sham laparotomy; and group III underwent ligation of the mesenteric vessels in the distal ileum. After 3 days, the kidneys, spleens, livers, and ileal segments were harvested for microbial and histologic analyses. Two piglets in the ischemic group died; microscopic examination showed severe histologic lesions of the ischemic area. Escherichia coli counts were increased in the ischemic segment compared to the upper loop (P < 0.05). Ischemia favoured staphylococcal colonization, whereas in the sham group a drastic reduction of these organisms was observed (P < 0.005). BT to the kidneys, spleen, and liver occurred normally in the control group. Ischemia significantly increased the total microflora in the spleen and liver (P < 0.05) and furthered dissemination of Clostridium perfringens in the kidneys (P < 0.05); 50% of ischemic animals had proteolytic clostridia in this organ (P < 0.05). Moreover, the incidence of E. coli in the kidneys, spleen, and liver was significantly higher in the sham and ischemic groups than in the controls (P < 0.05). Ileal ischemia thus induced significant histologic lesions, and surgery rather than gut microflora controls translocation.

The regulatory effects of whey retentate from bifidobacteria fermented milk on the microbiota of the Simulator of the Human Intestinal Microbial Ecosystem (SHIME).

AIMS: To investigate the effects of whey retentate from Bifidobacteria fermented milk. METHODS AND RESULTS: The simulator of the human intestinal microbial ecosystem (SHIME) was used. The composition of the microbiota and its metabolic activities were analysed. Changes in the microbial composition became apparent within 15 days of the treatment in the vessels representing the ileum and the large intestine. The whey retentate favoured the growth of endogenous bifidobacteria and induced a decrease in Bacteroides fragilis and in sulphite-reducing clostridia, especially Clostridium perfringens. After the administration was stopped, these populations tended to revert to their original levels, except for the streptococci and the staphylococci populations. The treatment also led to an increase in acetic acid, CH4 and CO2 production, suggesting overgrowth of some anaerobic bacteria. Ammonium, generally considered as undesirable, declined. CONCLUSIONS: The whey retentate clearly altered the microbial community in the SHIME. SIGNIFICANCE AND IMPACT OF THE STUDY: Whey retentate appears to exert a beneficial effect on the in vitro gastrointestinal system; these findings warrant confirmation by in vivo studies.

[Evolution of the result of respiratory function studies in children with bronchopulmonary dysplasia]. / Evolution du résultat des explorations fonctionnelles respiratoires chez les enfants atteints de dysplasie bronchopulmonaire.

BACKGROUND: Reports of short- and medium-term evolution of Lung Function Tests (LFT) in infants with bronchopulmonary dysplasia (BPD) are still scarce. POPULATION AND METHODS: The results of the first (before 3 months of corrected age) and the second (between 3 and 9 months of corrected age) LFT in 22 premature infants with BPD (gestational age 31 +/- 2.5 weeks; birth weight: 1570 +/- 440 g; duration of mechanical ventilation: 46 +/- 24 days, total duration of oxygen therapy: 88 +/- 47 days) were compared to those obtained in 27 normal infants for the first LEF and 10 normal infants for the second LFT, similar to the patients for birth weight and corporeal index (CI). RESULTS: In the first LFT, major abnormalities were an increased thoracic gaz volume (TGV) (16.5 +/- 42 vs 122 +/- 24 mL; P < 0.001) and TGV CI ratio (1.25 +/- 0.31 vs 0.89 +/- 0.17 ml/kg/m2; P < 0.0001) a decreased pulmonary compliance (2.49 +/- 1.46 vs 11.60 +/- 4.50 mL/cmH2O; P < 0.0001) and specific pulmonary compliance (0.015 +/- 0.10 vs 0.100 +/- 0.042 mL/cmH2O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (20.4 +/- 12.1 vs 10.5 +/- 5.3 cmH2O/L/s; P < 0.001). In the second LFT, an increased TGV (235 +/- 62 vs 166 +/- 28 mL; P < 0.01) and TGV CI ratio (1.64 +/- 0.65 vs 0.98 +/- 0.11 ml/kg/m2; P < 0.05), a decreased pulmonary compliance (2.68 +/- 2.0 vs 15.2 +/- 5.7 mL/cmH2O; P < 0.0001) and specific pulmonary compliance (0.013 +/- 0.010 vs 0.106 +/- 0.050 mL/cmH2O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (17.1 +/- 9.6 vs 8.6 +/- 4.9 cmH2O/L/s; P < 0.05) were noted when compared with the control group results. Major abnormalities of the blood gases were hypoxemia (63 +/- 10 vs 85 +/- 20 mmHg; P < 0.05), hypercapnia (38.5 vs 31 +/- 4 mmHg; P < 0.0001) during the first LFT. Hypoxemia (77 +/- 14 vs 90 +/- 14 mmHg and hypercapnia (37 +/- 4 vs 29 +/- 5 mmHg) continued in the second LFT. Thoracic distention and total pulmonary resistances in infants with BPD did not improve but their pulmonary compliance (P < 0.0001) and PaO2 (P < 0.01) between the first and second LFT did it. Infants who had been ventilated for a hyaline membrane disease (HMD) were more hypoxic on the second LFT (P < 0.05) than those who had been ventilated for other causes. Statistically significant relationships were found between thoracic distention and duration of positive inspiratory pressure (P < 0.05; r = 0.43), duration of positive expiratory pressure (P < 0.05, r = 0.45) total oxygen therapy duration; between total pulmonary resistance and duration of mechanical ventilation with high frequency (P < 0.05; r = 0.52); between hypoxemia and duration of oxygen therapy with FiO2 > or = 60% (P < 0.05; r = 0.54). CONCLUSIONS: This study shows prolonged clinical and functional abnormalities of the respiratory functions requiring longer follow-up.

[Malnutrition and immunodeficiency in children]. / Malnutrition et déficit immunitaire chez l'enfant.

Our knowledge on relationships between nutrition, immunity and infection has much progressed. Malnutrition affects all three defence mechanisms: unspecific immunity, cellular immunity and humoral immunity. Any kind of nutriment is concerned: nitrogen-caloric nutriments, trace elements, vitamins. Restoration and maintenance of a good nutritional status have become imperative in order to stop the vicious cercle of malnutrition-infection in infants and children.

Should an echocardiographic scan be done routinely for infants of diabetic mothers?

Several cardiologic pathologies are seen in infants of diabetic mothers (IDMs). Though asymmetrical septal hypertrophy (ASH) is a frequent pathology in IDMs, it is not routinely searched for with an echocardiographic scan. We have performed an echocardiographic examination for all IDMs (56 neonates) hospitalized between January 1987 and December 1992 in our neonatology and neonatal reanimation units. Of 56 patients, the diagnosis of 17 cases of ASH 930%) was made. The group with ASH (17 neonates) had a greater corporeal index than the group without ASH (39 neonates) (p < 0.05). Four of the 17 IDMs (24%) with ASH and one of the 39 IDMs (3%) without ASH presented with a cardiac insufficiency (p < 0.05). ASH is a pathology which should be searched for routinely IDMs.

[Retrospective analysis of 1331 samples of cerebrospinal fluid in newborn infants with suspected infection]. / Analyse rétrospective de 1331 échantillons de liquide céphalorachidien chez le nouveau-né suspect d'infection.

BACKGROUND: Definitive diagnosis of a neonatal infection usually requires recovery of an etiologic agent from body fluids or tissues such as spinal fluid, blood and urine. Routine lumbar puncture (LP) may raise some problems in interpreting results. POPULATION AND METHODS: A retrospective analysis of 1331 samples of CSF was made. LP had been performed on 1041 neonates including 569 prematures (54.6%) as a part of the evaluation for suspected bacterial infection. RESULTS: In 50.7% of the cases, the CSF was haemorrhagic. The frequency of traumatic taps increased with the degree of prematurity, low birth weight, precocity of LP, association with respiratory distress and disorders of coagulating factors. In addition, haemorragic taps modified biochemical and cytologic characteristics of CSF. One hundred and six (8%) CSF samples contained organisms but the diagnosis of meningitis was certain in only 23 cases (2.2%). In the other 83 cases, CSF was thought to be contaminated, mostly by coagulase-negative staphylococci. Since both blood and CSF cultures were positive for the same bacterial organism in 18 cases, it was concluded that the LP had been useful in identifying the pathogens in only five cases. The high frequency of contaminated CSF led to overestimation of the incidence of true bacterial meningitis (0.57% in our study). CONCLUSIONS: The low incidence of meningitis in neonates, the risk of having an haemorragic tap associated with the possibility of clinical aggravation during LP and the fact that the same pathogen is frequently (78.2% of cases) identified in blood cultures suggest that the immediate and routine LP is of less value than expected in infants suspected to be infected. LP could be postponed when the neonate presents with a respiratory distress syndrome and/or a precarious haemodynamic state.

[Role of home monitoring in the context of sudden infant death prevention. Current methods indications, monitoring]. / La place du monitorage à domicile dans le contexte de la prévention de la mort subite du nourrisson. Moyens actuels, indications, surveillance.

Some infants are cared with a home monitoring system during their first year of life. An international clinical consensus has been obtained and has proposed this technique mainly for infants who have presented an apparent life threatening event or for ex-premature with bradycardia or apnea, rather than for siblings of sudden infant death syndrome or other infants. In any case, this monitoring must be held after a complete clinical evaluation of the infant and after a real education of the parents about the use of the device. Many types of devices are used. The most efficient is the cardio-respiratory monitoring. Some of them include a processor and record the alarms. The need to see or to call the medical team to decode them allows close collaboration between the family and the clinical team. Knowledge of the alarms and the circumstances in which they have occurred help the medical team to propose the withdrawal of the home monitoring. Thus, sometimes preventive, sometimes prophylactic, this device will provide us for an optimal help.

[A case report of Russel's diencephalic cachexia]. / A propos d'une observation de cachexie diencéphalique de Russel.

The case of an infant admitted for evaluation of severe emaciation with intermittent ocular anomalies including strabismus and nystagmus is reported. This case demonstrates the value of magnetic resonance imaging and transfontanellar ultrasonography for the diagnosis of diencephalic syndrome of infancy. The prognosis of this condition is usually grim, in particular because of the severe emaciation which is disproportionate with the tumour spread. Pathophysiologic hypotheses put forward to explain this cachexia are reviewed. Although cytokines such as TNF alpha are currently incriminated in the pathophysiology of cachexia induced by a number of conditions, they have not yet been studied in diencephalic syndrome of infancy. TNF alpha is a potent lipolytic agent. Excessive production of TNF alpha may be involved in the genesis of the emaciation characteristic of diencephalic syndrome. Inappropriate production of TNF alpha may respond to the administration of specific anti-TNF monoclonal antibodies. This approach may be considered as a means for treating emaciation in patients with diencephalic syndrome of infancy.

[Home cardio-respiratory monitoring with alarm record system in infants at risk of life-threatening events]. / Surveillance cardiorespiratoire à domicile avec alarmes enregistrées chez des nourrissons à risque de malaises.

In few infants, home monitoring is useful to prevent recurrent apparently life-threatening events. Some devices have an alarm record system. We report our experience of home monitoring with such a device in 22 infants. 43.3% of the recorded events were considered as false alarms and 56.7% as true alarms. Among the alarms relative to abnormal respiratory events (38%), more than half occurred after two min of very low impedance thoracic signal. Among the true alarms relative to cardiac abnormalities (18.7%) more than half occurred during high amplitude fluctuations of the thoracic impedance signal and were relative to obstructive apnea or hypertonic vagal reactivity. Three infants presented an apparent life threatening event during an alarm, and two of them were hospitalized. These results indicate that it is important to define precisely the significance of the alarms during the survey of home monitoring of infants at risk for sudden infant death.

Neonatal thermoregulation.

The human being is a homeotherm. Homeothermy is a result of thermoregulation which includes many physiological processes. Thermoregulation maintains an equilibrium between heat production (thermogenesis) and heat loss (thermolysis). There are three principal modes of heat production: 1. Voluntary muscle activity. 2. Involuntary tonic or rhythmic muscle activity known as "shivering". 3. Non-shivering thermogenesis (NST) essential for newborns. Heat loss occurs in two stages: 1. The flow of heat from the center of the body to its surface. 2. The flow of heat from the body surface to the environment by conduction, convection, radiation or water evaporation. Even in the very small premature baby, we find that metabolic and vasomotor control responses are developed. To protect the newborn from stress resulting from hypo or hyperthermia, one should take into consideration the concept of the neutral temperature range which is also called the "Thermoneutral Zone" in (TNZ) or "Thermal Neutrality". Curves, proposed in 1971 by Hey are essential for keeping newborns in the TNZ.

[Embryonal rhabdomyosarcoma diagnosed antenatally]. / Rhabdomyosarcome embryonnaire de découverte anténatale.

A case of congenital embryonal rhabdomyosarcoma of the right shoulder is described. The patient was the first child born to a 24 year-old woman who had previously been treated for sterility. The diagnosis was made by echography during the 36th week of gestation. This full term white boy was born by cesarean section because of the tumor size. Surgical treatment was completed by chemotherapy. Despite 4 courses of VAC, local recurrence was noted that led to a second surgical excision followed by a new cyclic chemotherapy (IVA). The treatment was fairly well tolerated. The child is well 24 months later.

[Standardization of oculo-cardiac reflex in infants under 3 months of age]. / Standardisation du réflexe oculo-cardiaque chez les nourrissons de moins de 3 mois.

The authors present a standardization of the oculocardiac reflex carried out in early-age infants (under 3 months). This standardization is easy to perform. It takes into account the fall of the cardiac frequency, the asystoly and the range of bradycardia until its normalisation. Thus, it allows inter or intra individual comparison and can be applied to the study of infants at risk for sudden infant death syndrome.

[Epiglottitis and pulmonary edema in children]. / Epiglottite et oedème pulmonaire chez l'enfant.

A case of acute epiglottitis complicated by pulmonary edema, after intubation in a 30 month-old child is reported. The pathophysiology of this complication and its treatment associating oxygen therapy and positive end expiratory pressure are discussed.

[The importance of continuous ambulatory peritoneal dialysis technics in relation to intermittent peritoneal dialysis in acute renal insufficiency in children. Apropos of 7 cases]. / Intérêt des techniques de dialyse péritoneale continue ambulatoire par rapport à la dialyse péritonéale intermittente dans l'insuffisance rénale aiguë de l'enfant. A propos de sept observations.

We report seven cases of acute renal failure (ARF) treated by continuous ambulatory peritoneal dialysis (CAPD). ARF was caused by hemolytic uremic syndrome in six patients and acute fetal distress in one neonate. Mean age was 28 months (range 6 days-6 years). A flexible Tenckhoff catheter was inserted surgically under brief (10 minutes) general anesthesia in all patients. During the first 24 hours, in order to avoid clogging of the catheter, exchanges were done every 45 minutes with 20 ml/kg dialysate initially, gradually increased to 40-50 ml/kg. Thereafter, 5 to 8 exchanges were done every day (mean duration 9 days, range 4-21) until creatinine clearance reached 15 ml/mn/1.73 m2. No case of peritonitis or leakage was recorded. In two patients, migration of the straight catheter caused flow obstruction. None of the crook-shaped catheters migrated. Because dialysis was continuous and fluid balance could be controlled by using a hypertonic dialysate if called for, optimal protein (1-1.5 g/kg/d) and energy intake were possible. This intake was ensured mainly by continuous enteral nutrition. Improved patient comfort (no immobilization, no repeated punctures) and staff comfort (technical simplicity, independence from a cycler) are further non-negligeable advantages of CAPD.

[Treatment of acute renal failure by continuous hemofiltration in newborn infants and infants]. / Traitement de l'insuffisance rénale aiguë par hémofiltration continue chez le nouveau-né et le nourrisson.

During acute oligoanuric renal failure in neonates and infants, arteriovenous or veno-venous continuous hemofiltration is a simple, useful technique when peritoneal dialysis or hemodialysis cannot be used. It allows fluid removal, optimal calorie intake and mild blood purification, when waiting for diuresis to stabilize. It does not give any control over hypercatabolism; the use of continuous dialysis increases epuration.