Background Inhaled nitric oxide improves oxygenation in severely hypoxaemic term neonates, which lessens the need for extracorporeal-membrane oxygenation. Improvement in other relevant outcomes remains unknown, and safety of inhaled nitric oxide is uncertain In preterm neonates. We did a randomised controlled trial to assess use of inhaled nitric oxide in preterm and near-term neonates.Methods We randomly assigned 204 preterm (<33 weeks) and near-term (greater than or equal to 33 weeks) neonates with oxygenation indices from 12.5 to 30.0 and 15 to 40, respectively, 10 parts per million (ppm) inhaled nitric oxide (n=105) or control ventilation therapy without nitric oxide (n=99). The primary endpoint was the oxygenation index at 2 h. Analysis was done by intention to treat.Findings 12 neonates were excluded, leaving 97 (45 preterm) in the nitric-oxide group and 95 (40 preterm) in the control group. The decline in oxygenation index at 2 h was greater in the nitric-oxide group than in the control group (IQR 6.2 [median 8.4] vs -2.9 [12.4], p=0.005), but was significant only in near-term neonates (p=0.03). Survivors assigned nitric oxide spent fewer days on mechanical ventilation and in the neonatal intensive-care unit, but this was also significant only in near-term neonates (6 [3] vs 7 [3] days, p=0.05, and 9 [6] vs 12 [9] days, p=0.02, respectively).Interpretation Low-dose inhaled nitric oxide early in the course of neonatal respiratory failure improves oxygenation and shortens duration of mechanical ventilation and the length of stay in intensive care. Inhaled nitric oxide was not, however, significantly beneficial in preterm neonates.

Single-lumen umbilical venous catheters are widely used in pediatric intensive care units to administer solutes and drugs and to collect blood samples. Multiple venous lines are often required either because of a need for continuous infusion of drugs (e.g., vasoactive agents) or because of drug-drug incompatibilities. This problem can theoretically be overcome by using a double-lumen umbilical catheter. A study was conducted to evaluate the ease of insertion and safety of a percutaneous dual-lumen catheter (3.5 CHx38 cm ARROW) versus a single-lumen umbilical catheter (4Frx13 cm SHERWOOD). Twenty neonates whose clinical condition required a central venous line were included and randomized to the single-lumen (n = 10, group I) or dual-lumen (n = 10, group II) catheter. No statistically significant differences in gestational age, birth weight, or catheter use duration were seen between the two groups, Insertion was difficult in two group I and six group II infants. Peripheral venipuncture for blood sample collection was required in two group I infants and in one group II infant. No nosocomial infections were recorded. Percutaneous dual-lumen venous umbilical catheters are useful and safe. They theoretically reduce the need for inserting other catheters and for performing peripheral venipuncture for blood sample collection, thus improving patient comfort and saving caregiver time. They are not associated with increased risks of mechanical or infectious complications. However, they are sometimes difficult to insert.

Les catheters veineux ombilicaux a simple lumiere sont largement utilises en reanimation pediatrique pour l'administration de perfusions et de medicaments, ou la realisation de prelevements sanguins. La perfusion continue de medicaments en particulier vaso-actifs ou l'incompatibilite de medicaments entre eux rendent cependant necessaire la mise en place de voies veineuses multiples. Cet inconvenient pourrait etre theoriquement evite par l'utilisation d'un catheter a double lumiere par voie ombilicale. Nous avons analyse la facilite de mise en place des catheters percutanes a double lumiere (3,5 CH x 38 cm ARROW) et compare les complications liees a leur utilisation par rapport aux catheters veineux ombilicaux simple lumiere (4Fr x 13 cm SHERWOOD). Vingt nouveau-nes malades necessitant la pose d'une voie veineuse centrale ont ete inclus. Le choix du catheter a ete tire au sort. Vingt catheters ont ete poses, dont dix a simple lumiere (groupe I) et dix a double lumiere (groupe II). L'âge gestationnel, le poids de naissance et la duree d'utilisation des catheters etaient statistiquement comparables dans les deux groupes. Des difficultes lors de la pose ont ete notees respectivement chez 2 et 6 enfants. Des prelevements sanguins par voie veineuse peripherique ont ete necessaires respectivement chez 2 et 1 nouveau-nes. Aucune infection nosocomiale n'a ete mise en evidence. L'utilisation de catheters veineux a double lumiere percutanes par voie ombilicale est utile et bien toleree. Elle limite theoriquement la necessite d'autres catheters ou de ponctions veineuses peripheriques, ameliorant le confort du nouveau-ne et diminuant la charge de travail infirmier. Elle n'augmente pas les risques mecaniques ou infectieux. Son insertion est cependant parfois difficile a realiser.

Le rein maintient dans des limites étroites la concentration et le volume du milieu intérieur. II le fait gràce á la sécrétion d'hormone antidiurétique (ADH), elle-même sous le contrôle des osmorécepteurs hypothalamiques. Le debil urinaire et l'excrétion de la plupart des électrolytes suivent un rythme nycthéméral: ils augmentent au cours de la journée et dimnuent au cours de la nuit. Ce rythme nyethéméral serait absent chez certains sujets qui, en raison d'une polyune nocturne relative, présenteraient une miction involontaire due à l'état de réplétion vésicale. Chez ces sujets, la polyurie est associatée à une diminution de la sécrétion nocturne d'ADH et à l'excrétion d'urines diluées. Ce déficit nocturne de la sécrétion d'ADH expliquerait la bonne réponse à la desmopressine chez les enfants présentant une énurésie nocturne ⪡polyurique⪢.Body fluid homeostasis is maintained by the kidney. Such an accurate control in achieved via the secretion of antidiuretic hormone (ADH), the secretion of which is regulated by hypothalamic osmoreceptors. Both urine flow rate and the excretion of most electrolytes have a diurnal rhythm: they increase during daytime and decrease during nightime. Such a rhythm seems to be absent in some subjects who suffer from bedwetting because of relative polyuria. In these cases, the polyuria is associated with a decreased nocturnal secretion of ADH and the subsequent excretion of diluted urine. A deficit in the nocturnal secretion of ADH thus appears to explain the response to desmopressin of children with a polyuric form of enuresis.

Hypokalemia and hyponatremia increase the occurrence of atrial fibrillation. Sinoatrial nodes (SANs) and pulmonary veins (PVs) play a critical role in the pathophysiology of atrial fibrillation.The purpose of this study was to evaluate whether electrolyte disturbances with low concentrations of potassium ([K+]) or sodium ([Na+]) modulate SAN and PV electrical activity and arrhythmogenesis, and to investigate potential underlying mechanisms.Conventional microelectrodes were used to record electrical activity in rabbit SAN and PV tissue preparations before and after perfusion with different low [K+] or [Na+], interacting with the Na+–Ca2+ exchanger inhibitor KB-R7943 (10 μΜ).Low [K+] (3.5, 3, 2.5, and 2 mM) decreased beating rates in PV cardiomyocytes with genesis of delayed afterdepolarizations (DADs), burst firing, and increased diastolic tension. Low [K+] (3.5, 3, 2.5, and 2 mM) also decreased SAN beating rates, with genesis of DADs. Low [Na+] increased PV diastolic tension, DADs, and burst firing, which was attenuated in the co-superfusion with low [K+] (2 mM). In contrast, low [Na+] had little effect on SAN electrical activities. KB-R7943 (10 μΜ) reduced the occurrences of low [K+] (2 mM)– or low [Na+] (110 mM)–induced DAD and burst firing in both PVs and SANs.Low [K+] and low [Na+] differentially modulate SAN and PV electrical properties. Low [K+]– or low [Na+]–induced slowing of SAN beating rate and genesis of PV burst firing may contribute to the high occurrence of atrial fibrillation during hypokalemia or hyponatremia.

Nosocomial respiratory tract infections due to respiratory syncytial virus are common among hospitalized children. The overall prevention lis based on 3 points: prevention of person-to-person viral transmission infection surveillance and staff education. Handwashing is the main protective attitude. Other measures such as gloving, gowning and wearing masks and goggles are discussed. Changes in hospital organisation during epidemic periodes must also be considered.

Severe head injuries in infants have specific circumstances such as obstetrical injury, battered infant, shaken infant. Pediatric scales must be used for neurological evaluation, the Bicêtre scale being a sensitive index of clinical course. Transfontanellar ultrasound can be useful as first line tool of evaluation of brain injury, but computerized tomography scan is necessary to correctly assess the brain lesions and the presence of hematoma. Hemorragic lesions can rapidly lead to hypovolemic state which must be prevented, or treated without delay. Treatment requires hemodynamics and hydroelectrolytic support, measures to control intracranial hypertension, sedation, and neurosurgical intervention according to the hemorragic lesions.

Nosocomial respiratory tract infections due to respiratory syncytial virus are common among hospitalized children. The overall prevention is based on 3 points: prevention of person-to-person viral transmission, infection surveillance and staff education. Handwashing is the main protective attitude. Other measures such as gloving, gowning and wearing masks and goggles are discussed. Changes in hospital organisation during epidemic periodes must also be considered.

Un certain nombre de circonstances de survenue des traumatismes crâniens graves sont spécifiques au nouveau-né et au nourrisson (traumatisme obstétrical, sévices, enfant secoué). À cet âge, l'évaluation neurologique doit faire appel aux échelles pédiatriques, tout particulièrement celle de Bicêtre. La tomodensitométrie cérébrale doit compléter au moindre doute l'échographie transfontanellaire pour préciser les lésions cérébrales et la présence d'hématome. Les lésions hémorragiques peuvent entraîner un choe hypovolémique qu'il convient de prévenir ou de traiter rapidement. Le traitement doit associer le maintien des équilibres hémodynamique, hydroélectrolytique et glucidique, le traitement de l'hypertension intracrânienne, la neurosédation et la prise en charge neurochirurgicale des collections sanguines.

Les infections respiratoires nosocomiales liées au virus respiratoire syncytial (VRS) représentent un problème important dans les services hospitaliers de pédiatrie. La prévention repose sur trois volets : prévention de la transmission primaire et secondaire, surveillance de l'épidémie et enseignement de la transmission virale et de sa prévention. Le lavage des mains en est la mesure essentielle. D'autres mesures incluant le port de gants, de masque, de blouse et de lunettes protectrices sont discutées. Une modification de l'organisation hospitalière en période épidémique facilite la prévention.

The aim of this prospective study was to evaluate the incidence of viral respiratory infection in hospitalized premature newborn infants and to assess the role of coronaviruses. All hospitalized premature infants with a gestational age less than or equal to 32 weeks were included. Tracheal or nasopharyngal specimens were studied by immunofluorescence for coronaviruses, respiratory syncytial virus, adenoviruses, influenza and parainfluenza viruses. Forty premature infants were included; 13 samples were positive in 10 newborns (coronaviruses n = 10; influenza 1 n = 2; adenovirus n = 1). None was positive at admission. All premature infants infected with coronaviruses had symptoms of bradycardia, apnea, hypoxemia, fever or abdominal distension. Chest X-ray revealed diffuse infiltrates in two cases. However, no significant difference was observed between infected and non-infected premature infants for gestational age, birth weight, duration of ventilation, age at discharge, incidence of apnea or bradycardia. Nosocomial respiratory tract infection with coronaviruses appears to be frequent. The clinical consequences should be evaluated in a larger population.

Cushing's disease (CD) is the most common etiology of Cushing's syndrome (CD) due to corticotroph pituitary adenoma, which are in most cases small (80–90% microadenomas) and in about 40% cannot be visualized on imaging of the sella. First-line treatment for CD is transsphenoidal surgery (TSS) with the aim of complete adenoma removal and preservation of pituitary gland function. As complete adenoma resection is not always possible, surgical failure is a common problem. This can be the case either due to persistent hypercortisolism after first TSS or recurrence of hypercortisolism after initially achieving remission. For these scenarios exist several therapeutic options with their inherent characteristics, which will be covered by this review.

Les taux urinaires d'opiaces totaux doses par adaptation quantitative de la methode EMIT ont ete mesures chez 3 nouveau-nes, dont 2 prematures, de mere intoxiquee a la codeine (5 a 38 comprimes par jour de Neo-Codion® soit 75 a 570 mg de codeine). L'elimination de la codeine chez le nouveau-ne a terme semble aussi rapide que chez l'adulte et parait plus lente chez le premature. Ce travail suggere que les voies d'elimination du nouveau-ne d'âge gestationnel de 35 semaines d'amenorrhee sont encore immatures pour la codeine

Background. - Spontaneous umbilical cord hematoma is a rare life-threatening gestational accident.Case report. - A 26 year-old primipara was examined at 38 weeks of gestation for fetal monitoring. There were a number of fetal decelerations with loss of baseline variability. Cesarean section performed for acute fetal distress resulted in a male infant with an Apgar score of 3 at 1 minute and 7 at 5 minutes and neonatal anemia (Hb: 11.6 g/l). Four umbilical cord hematomas were observed. Microscopic examination revealed a ruptured umbilical vein without other abnormality. Post natal evolution was marked by hypoxic-ischemic encephalopathy and death.Conclusion. - Spontaneous umbilical cord hematoma is rare (1/5,500 births) and often due to rupture of the umbilical vein. Risk factors are shortness or traction of the cord, post-maturity and infection. Umbilical cord hematomas are usually responsible for severe fetal distress or death.

Total urinary excretion of narcotics was measured using a quantitative EMIT variant in three neonates born to codeine-abusers (75 to 570 mg codeine/day). Two of the infants were born prematurely. The codeine elimination rate was similar to that in adults in the full-term neonate and slower in the premature babies. Data from this study suggest that neonates with a gestational age of 35 weeks (as determined by menstrual history) have immature codeine elimination processes.