Syndrome d'activation macrophagique secondaire chez l'enfant. Rapport de 5 cas sénégalais

Le Syndrome d'Activation Macrophagique (SAM) est défini comme la traduction clinico-biologique d'une prolifération et d'une activation non-spécifique des macrophages du système réticulo-histiocytaire avec phagocytose des éléments figurés du sang. Nous rapportons 5 cas de SAM secondaires chez des enfants hospitalisés dans le service de pédiatrie de l'hôpital Aristide le Dantec entre août 2015 et avril 2016. Il s'agissait de 3 filles et 2 garçons âgés de 7 ans à 14 ans. Cliniquement, la fièvre, l'altération de l'état général et la splénomégalie étaient constantes. Quatre patients ont présenté des adénopathies et chez 2 patients une hépatomégalie a été retrouvée. Au niveau de l'hémogramme, l'anémie était constante, la thrombopénie et la leuco-neutropénie étaient retrouvées chez 3 patients et le frottis sanguin révélait 36% de blastes chez un patient. L'hémophagocytose médullaire était retrouvée chez tous les patients, l'hyper ferritinémie était constante et chez trois patients une hypertriglycéridémie avec un taux élevé de lactate déshydrogénase (LDH) ont été notés. Le diagnostic était surtout guidé par le médullogramme et basé sur les critères de l'hemophagocytic histiocytosis et les étiologies étaient infectieuses et néoplasiques. Chez trois patients, le SAM était d'origine infectieuse et les germes retrouvés étaient le Streptococcus, l'Escherichia coli et le Mycobacterium tuberculosis alors que les deux autres cas étaient d'origines néoplasiques secondaires à une leucémie aiguë myéloïde et à un lymphome hodgkinien. Le traitement était basé sur l'antibiothérapie (cas 1 et 2), les antituberculeux (cas 3) et la chimiothérapie (cas 4 et 5). L'évolution était favorable chez tous nos patients

[Dehydration and malnutrition as two independent risk factors of death in a Senegalese pediatric hospital]. / Déshydratation et malnutrition : deux facteurs de risque de décès indépendants chez l'enfant sénégalais hospitalisé

UNLABELLED: Inpatient mortality is an indicator of the quality of care. We analyzed the mortality of under 5-year-old hospitalized children in the pediatric ward of Aristide Le Dantec Hospital for updating our data 10 years after our first study. METHODS: We analyzed the data of the children hospitalized between 1 January and 31 December 2012. For each child, we collected anthropometric measurements converted to a z-score related to World Health Organization growth data. Logistic regression-generating models built separately with different anthropometric parameters were used to assess the risk of mortality according to children's characteristics. RESULTS: Data from 393 children were included. The overall mortality rate was 10% (39/393). Using logistic regression, the risk factors associated with death were severe wasting (odds ratio [OR]=8.27; 95% confidence interval [95% CI]) [3.79-18], male gender (OR=2.98; 95% CI [1.25-7.1]), dehydration (OR=5.4; 95% CI [2.54-13.43]) in the model using the weight-for-height z-score; male gender (OR=2.5; 95% CI [1.11-5.63]), dehydration (OR=8.43; 95% CI [3.83-18.5]) in the model using the height-for-age z-score; male gender (OR=2.7; 95% CI [1.19-6.24]), dehydration (OR=7.5; 95% CI [3.39-16.76]), severe deficit in the weight-for-age z-score (OR=2.4; 95% CI [1.11-5.63]) in the model using the weight-for-age z-score; and male gender (OR=2.5; 95% CI [1.11-5.63]) and dehydration (OR=8.43; 94% CI [3.83-18.5]) in the last model with mid-upper arm circumference (MUAC). Dehydration and malnutrition were two independent risk factors of death. The protocols addressing dehydration and malnutrition management should be audited and performed systematically for each child's anthropometric measurements at admission.

[Diagnostic and evolutionary aspects of hemorrhagic syndromes of the newborn in Dakar]. / Aspects diagnostique et évolutif des syndromes hémorragiques du nouveau-né à Dakar.

BACKGROUND: Hemorrhage is a common and serious symptom in the neonatal period. In developing countries, means of exploration are insufficient. Our purpose was to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of hemorrhagic syndromes of the newborn in Dakar, Senegal, to identify the risk factors and diseases associated with them in order to propose recommendations for their management. METHODS: We conducted a case-control study of 82 newborns with 41 cases of hemorrhagic syndromes and 41 controls. We first described the epidemiological, diagnostic, therapeutic, and evolutionary parameters of the group that submitted a hemorrhagic syndrome and compared their diagnostic data with those of the control group to highlight the risk factors associated with the occurrence of hemorrhagic syndrome. RESULTS: The prevalence of hemorrhagic syndrome among hospitalized newborns was 9.2%, the sex-ratio (M/F) was 1.9. Preterm infants accounted for 26.8%. We often found early onset of bleeding (46.4% before 72h of life). Visceral bleeding was predominant, especially respiratory (34.1%), digestive (31.7%), and cerebral (17%), followed by cutaneous hemorrhages (26.8%). The risk factors identified were respiratory distress, shock, and a stained amniotic fluid. The concomitant diagnoses were dominated by neonatal infection (58.5%), hemorrhagic disease of the newborn (21.9%), and disseminated intravascular coagulation (19.5%). The mortality rate was high (34.1%), most often associated with disseminated intravascular coagulation. CONCLUSION: This study reveals the high mortality due to hemorrhagic syndromes caused by these three diseases for which prevention must be stressed.

[Assessment of the state and future of basic neonatal resuscitation equipment, in first-line health facilities in Senegal after 3years]. / Évaluation de l'état et du devenir du matériel de base destiné à la prise en charge du nouveau-né à la naissance dans les structures sanitaires périphériques au Sénégal, après un recul de trois ans.

BACKGROUND: Neonatal mortality is a major public health problem. The main causes are infections, prematurity and asphyxia at birth. In view of reducing this high mortality, primary healthcare facilities were equipped with basic equipment for the care of newborns and their key workers were trained in essential newborn care. Three years after this implementation, the present study assesses the state and conditions of use of this basic equipment intended for taking care of newborns at birth. METHOD: This assessment was conducted from 16 March to 3 April 2009. It was based on observations and interviews on a sample of healthcare facilities. RESULTS: Healthcare facilities were generally equipped with ventilator bags and masks (87%) (60/69). In more than half of the healthcare centers (20/38), they were not used often because the workers were renewed and not educated in their use. They were practically all in good condition. Eighty-five percent (59/69) of healthcare facilities had at least one aspirator, generally adapted to newborns (negative pressure, 100 mmHg). The maintenance of the material was globally satisfactory because the aspirator bottles were most often clean. As for the aspirator tubes, they were always available but a few cases of supply rupture were observed in some healthcare centers. The warming table was available in only 52% (36/69) of healthcare facilities. Fifteen tables did not comply with initial specifications. CONCLUSION: This assessment highlights that the basic equipment intended for newborn care was generally available, functional and maintained well after 3 years. This strategy could be scaled up in order to contribute to reducing the newborn mortality.

Intoxicatrion accidentelle par ingestion de fer chez l'enfant : a propos de deux cas a Dakar

Introduction : L'intoxication au fer est un motif exceptionnel d'hospitalisation en pediatrie au centre hospitalier universitaire de Dakar.Observations : Nous rapportons les observations de deux enfants de 3 ans et 20 mois admis au service d'urgence pediatrique de l'hopital Aristide Le Dantec pour une intoxication de moderee a severe apres l'absorption d'une quantite importante de sulfate de fer. Les manifestations cliniques etaient dominees par les troubles digestifs et les troubles neurologiques a type de convulsions tonico-cloniques et de coma stade I. Le dosage sanguin du fer montrait des taux au dessus des limites normales. L'evolution clinique etait satisfaisante apres le lavage gastrique et les mesures de reanimation. Conclusion : Un diagnostic precoce et une prise en charge diligente des cas d'intoxication au fer permet d'en reduire la morbidite et la mortalite. Nous insistons egalement sur l'information des familles pour une meilleure securisation des comprimes de fer prescrits aux adultes

[Low level educated community health workers training: a strategy to improve children access to acute respiratory treatment in Senegal]. / La formation des agents de santé communautaire instruits: une stratégie pour améliorer l'accès des enfants au traitement des infections respiratoires aiguës au Sénégal.

BACKGROUND: Acute respiratory infections (ARI) are the leading cause of death in childhood. Most of children's deaths happen at home without health level first cares. However in Senegal only health workers are allowed to prescribe antibiotics. A competency-based training was developed to improve and assess the management of acute respiratory infections in young children aged 2 to 59 months by low level educated community health workers (CHWs) in 4 districts of Senegal. The first findings showed the CHWs capable of acquiring the skills needed to effectively manage ARI cases in accordance with the World Health Organization's ARI case management strategy. The aim of this study was to assess the quality of their management after a 1 year follow-up. METHODS: We provided to CHWs 3 days course in ARI management. After the 3-day course, a 4-month follow-up was performed. We organized a 1-day refresher course every month and in every district. In order to assess the quality of management of CHWs we analyzed the management process and compared the CHWs classification to the classification of the first level health facilities. RESULTS: Twenty-three percent (3727/15,965) of IRA cases of district were managed by CHWs. Ninety percent (2738/3042) among them were well classified, well managed and well followed-up. But 28% of severe pneumonia cases were misclassified as pneumonia. About treatment, 22.5% of 'cough or cold' got wrong treatment with cotrimoxazole and 10.3% of severe pneumonia got cotrimoxazole without referral. Less than half of severe pneumonia benefited of the first follow-up and only 18% of the second. CONCLUSIONS: The results highlight that a CHWs low-level educated in French, trained and followed-up could apply the WHO algorithm of IRA management. They could help to give proximal care related to children ARI, to the community. But it seems useful of emphasizing the recognition of danger signs and the follow-up of severe cases.

[Efficiency of kangaroo care on thermoregulation and weight gain of a preterm newborn cohort in Dakar]. / Efficacite de l'elevage par la methode kangourou sur la thermo- regulation et le gain ponderal d'une cohorte de prematures.

AIM OF THIS STUDY: to evaluate the efficacy of kangaroo method on thermoregulation and weight gain of a cohort of preterm. METHODS: it is a retrospective study based on files of preterm baby weighting below 2000 g, included after discharge to neonatal unit of Aristide Le Dantec maternity for kangaroo method care. Efficiency was appreciated on thermic curve evolution and daily weight gain. RESULTS: 56 preterm babies were including. Mean gestational age was 33 +/- 7,6 weeks and mean birth weight, 1488 +/- 277,6 g (median = 1500 g). Mean temperature was satisfying during follow up and was stable around 37 +/- 0,5 degrees C at discharge of program with mean daily weight gain of 33 +/- 7,6 g. We had only one case of death. CONCLUSION: The results of this study point out efficacy of kangaroo method on thermoregulation, weight gain and survival of preterm babies. We advocate for promotion in developing countries because of its low cost.

[Beckwith-Wiedemann syndrom: a case report in Dakar]. / Le syndrome de Beckwith-Wiedemann. A propos d'un cas a Dakar.

BACKGROUND: Beckwith-Wiedemann syndrome is a congenital syndrome with variable phenotypic expression. It is less commonly described in Africa. We report a case in Dakar universitary hospital center. OBSERVATION: This report is about a two month old child from Mauritania presenting an hemihypertrophy, macroglassia and an umbilical hernia. Glycemia was under normal level showing a mild hypoglycemia (0,6 g/dl). T3, T4 and TSH values were in normal range. Abdominal echography was normal. Our patient was stable at the first clinical examination. CONCLUSION: we advocate for dietetic measures and rigorous clinical follow up, every 3 to 6 month, to screen for recurrent hypoglycaemia and the occurence of an eventual neoplasmic desorders.

[Assessment of management training for low-level community health workers providing care for children with acute respiratory infections in four districts of Senegal]. / Formation d'agents de santé communautaire à la prise en charge des infections respiratoires aiguës de l'enfant.

BACKGROUND: Acute respiratory infections are the leading cause of death in childhood and most child deaths in Senegal occur at home without qualified health care. Despite this situation, only qualified healthcare workers are authorized to prescribe antibiotics. A competency-based training program was developed to improve and assess management of acute respiratory infections in young children aged between 2 and 59 months by low-level educated community health workers (CHWs) in four districts of Senegal. METHODS: In accordance with the strategy developed by the World Health Organisation, educated low-level community health workers in four district of Senegal were given a three-day course on the management of acute respiratory failure. We assessed the effects of the course by comparing pre-training and post-training skills with the Students t test. RESULTS: The results showed that the educated low-level community health workers were capable of acquiring the skills needed to effectively manage children with acute respiratory failure. CONCLUSION: Further evaluation is needed to determine the mid- and long-term effects of the course and supervised post-training activities.

[Neonatal mortality associated with transfer of low birth weight newborns. Assessment of a neonatal care unit of Dakar]. / Mortalité néonatale associée au transfert des nouveau-nés de petit poids. Bilan d'une unité de néonatologie de Dakar.

The aim of this study is to assess mortality rate of low birth weight newborns admitted to a neonatal care unit of Dakar after transfer. This retrospective study include all newborns weighing less than 2500 g transferred to Abass Ndao neonatal care unit between January 1st,1998 and December 31, 1999. Maternal, newborns and transfer related parameters were studied. Data of 180 new-borns were recorded from a sample of 247 babies transferred. The mean weight of these babies were 1452.5 +/- 432 g. An ambulance was used for transport in only 10% of cases. The median time of admission after birth was 3 hours. Median delay of admission and methods of transfer, maternal age and parity, apgar score at 1st and 5th minute were comparable between the newborns deceased and survivors (p > 0.05). To reduce mortality associated with newborns transfer, we insist on a better organisation of neonatal transport in under developed countries by promoting obstetricians and paediatricians collaboration and prevention of low birth weight.