Pédiatrie
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Comparative Study
[Extracorporeal oxygenation and extracorporeal respiratory assistance in newborn infants].
The authors present the principle and discusses the indications and contraindications of two technics of extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure, respectively veno-arterial and veno-venous. The two technics appear to give comparable results. They are indicated in neonates with refractory hypoxemia after failure of other methods such as surfactant, high frequency oscillatory ventilation and nitrous monoxyde.
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With few exceptions in extremely rare circumstances, such as sign of raised intracranial pressure, a lumbar puncture must be performed whenever the diagnosis of meningitis is suspected in a child. It serves to confirm a diagnosis of purulent meningitis, to identify the bacteria and to test its sensitivity to antibiotics. If the child responds appropriately to therapy, some authors recommend no further examination of cerebrospinal fluid (CSF). ⋯ Apart from its bacteriological interest, this second lumbar puncture seems to be a prognostic indicator of the incidence of neurological abnormalities. No further CSF examination is necessary when the patient's course of illness is uncomplicated. On the other hand, the presence or appearance of neurological abnormalities during the daily physical and neurological examination compels a new lumbar puncture and a CT scan to search for a persistent central nervous system infection or a complication of the meningitis.
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The authors report on a case of cardiomyopathy with congestive heart failure in an infant with severe hypocalcemia related to vitamin D deficient rickets. The heart failure was successfully treated with calcium gluconate and vitamin D, associated with dobutamide.
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One of the aspects of prematurity in neonates is the respiratory distress syndrome. Although treatment with mechanical ventilation reduced the mortality rate, bronchopulmonary dysplasia still develops in many neonates. We have attempted to reduce intubation and mechanical ventilation by using, in the delivery room, humidified and warmed gas with fractional inspired oxygen as low as possible to obtain SaO2 between 85 and 95%. ⋯ Seven out of 26 infants (27%) born between 30 and 32 weeks required mechanical ventilation. In contrast, ventilation was necessary for eight out of 16 premature neonates born before the 29th week of gestation. Mortality rate was 6% (4/66) in the latter group (< 29 weeks), and only one neonate developed bronchopulmonary dysplasia.
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Regarding a case of beta-ketothiolase deficiency revealed by ketoacidosis with hyperglycinemia, the authors show the way to diagnose and to treat this disease. Ketoacidosis without hyperglycemia or lactacidemia suggested this diagnosis. ⋯ The treatment of acute episodes consisted of acidosis control and exclusive glucides intake before diagnosis. Afterwards, a controlled proditic diet and L-carnitine must be given and fasting must be avoided.