L′annonce d′une maladie neurologique grave chez un enfant entraîne un traumatisme majeur pour la personne concern e, pour sa famille qui la reçoit et pourl′équipe qui doit l′annoncer après en avoir fait le diagnostic. Si l′impact d′une telle annonce dépend de la gravité ultime de la maladie, il dépend aussi de l′organeatteint, le cerveau.
The development of cardiorespirography with data processing enable to perform polygraphic recordings. However the standardized results supplied by this new generation of equipment cannot be used directly and need to be validated and analized by the clinician. The confrontation of the cardiac and respiratory curves allows a semiological analysis of the cardiac and respiratory functions and of their relationships in the various syndromic contexts encountered in the neonate (bradycardia and other cardiac arythmia, central or obstructive apnea, thoracic hypoampliation, periodic breathing).
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.
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.
