Objective: Cerebral venous thrombosis (CVT) in children is rare but associated with a high rate of sequelae. The objective of this study were (i) to assess whether initial presentation and evolution were influenced by the pathophysiological mechanism underlying the disease, (ii) to individualize the independent factors associated with long-term prognosis. Methods: A retrospective single-center study in a university hospital, including all children with CVT between 2004 and 2014. Neonatal cases were excluded. CVT were classified by an expert group as (i) from a local (i.e. head or neck) infection or trauma, (ii) associated with a systemic prothrombotic disease. Long-term prognosis was evaluated by the neurological impairment score (NIS). Influence of the pathophysiological mechanism was analyzed by univariate analysis, and factors associated with the NIS were studied by logistic regression. Results: 40 children (boys 64%) with a mean age of 5 (4.9) years were included. A local cause was indicated in 62.5% of them. Fever was more systematic at presentation in these patients (p<0.00001). Their evolution was also marked by a shorter period for vein repermeation with anticoagulation (2.65 vs 4.75 months, p=0.04), and a lower rate of major sequelae (16% vs 53%, p=0.0006). A local infection or trauma was the only factor associated with a favorable NIS (OR: 6.0, 95% CI: 1.2–37.0, p=0.03). Conclusion: In our population, a local infection or trauma was the main pathophysiological mechanism underlying CVT. This condition was also associated with a better prognosis. Future studies could aim to tailor the duration of anticoagulation to the mechanism of cerebral venous thrombosis in children.

Touchant près de 2,5 pour 1 000 naissances, l’encéphalopathie anoxo-ischémique (EAI) reste associée à une mortalité et à une morbidité neurologique à long terme élevée, bien que diminuée récemment par l’avènement de l’hypothermie thérapeutique. Le développement d’outils pronostiques fiables et pertinents est nécessaire pour guider la démarche thérapeutique et éthique. L’EEG à j2-j3, l’IRM de diffusion avant j7, l’IRM conventionnelle dans les deux premières semaines de vie et l’examen clinique après réchauffement semblent répondre le mieux à ces critères.

We report a case of moderate intrauterine growth delay with a congenital skull fracture and subdural hematoma, related to Menkes disease. The diagnosis was established in the neonatal period and absorptiometry showed global osteopenia. This disorder has an X-linked recessive inheritance pattern. It results from all abnormality in copper transport with a reduction in the ability to incorporate copper into certain enzymes that need it as a cofactor. The clinical phenotype stems from a deficiency of these enzymes, which explains the diversity of the symptoms. It begins in the first months of life with neurological disorders (hypotonia, seizures) and bone and vascular abnormalities. Usually, death occurs before the age of 5. (C) 2008 Elsevier Masson SAS. All rights reserved.

Background: Intermittent infusion of vancomycin is widely used to treat late-onset sepsis in neonates. On the other hand, the continuous infusion of vancomycin could improve bactericidal efficacy since its action is time dependent.Objective: To evaluate a simplified dosage schedule for continuous-infusion vancomycin therapy.Methods: Prospective study in premature neonates (<34 weeks) with suspected coagulase-negative staphylococci (CoNS) sepsis. Before antibiotics at time zero (TO), serum creatinine was measured and blood cultures were collected. Vancomycin dosage began with 25 mg/kg/day or 15 mg/kg/day (period 1) and 30 mg/kg/day or 20 mg/kg/day (period 2) depending on whether serum creatinine was below or above 90 mu mol/l. Two days after beginning treatment (first timepoint: T1), serum vancomycin was measured and second blood cultures were collected.Results: Between June 2002 and December 2005, 145 neonates were evaluated. At birth, the median (inter-quartile range) body weight was 920 (500-1160) g and gestational age was 28 (26-29) weeks. At T1, serum vancomycin was within the required range in 74.5% of neonates (108/145). Serum vancomycin levels were higher in period 2 than in period 1 (20 mg/l vs 13 mg/l, p<0.05). At TO, 55% (80/145) of blood cultures were positive for CoNS, but 71% (57/80) were negative at T1. Four days after beginning treatment, 929% of subjects had recovered without removing the central venous catheter.Conclusion: Using this simplified dosage schedule, bactericidal efficacy was maintained and most Subjects had serum vancomycin concentrations within the therapeutic range.

Introduction All newborn acute pain scores require face observation. Using linen protecting from light aggressiveness as well as non-invasive ventilation masks make the face less accessible. The point is to validate FANS scale (Faceless Acute Pain Neonatal Scale) ignoring face survey. Methodology Prospective multi-centric study. We filmed premature babies (24–40 weeks of gestation) during a painful care (venipuncture). Three observers assessed pain with FANS and a validated score: DAN (Acute Pain of Neonate). The FANS based on movements, screaming and vegetative reactions survey. Reliability study included: inter-observers agreement and internal consistency (Cronbach alpha coefficient). Validity study included: intraclass correlation coefficient (ICC) between the 2 scales. To assess the discriminating ability towards painful and non-painful stimulation, 10 patients were observed (watched ? surveyed ?) during thigh rubbing and during puncture. FANS’score difference between the two situations were studied according to Wilcoxon test. Results From April 2006 to September 2007, 53 prematures 32 [30–35] weeks and 1500 [1000–2200] g. were observed (watched?). Cronbach alpha coefficient is 0.72. ICC were 0.92 [0.9–0.98] for inter-observer agreement and 0.88 [0.76–0.93] for scales correlation. The scores are significantly higher during the painful events/non painful stimulation: (3 [2–5] vs 1 [0–1], p Conclusion FANS scale seems reliable and valid. It is the very first scale to assess pain when face is inaccessible to survey.

We report a case of moderate intrauterine growth delay with a congenital skull fracture and subdural hematoma, related to Menkes disease. The diagnosis was established in the neonatal period and absorptiometry showed global osteopenia. This disorder has an X-linked recessive inheritance pattern. It results from an abnormality in copper transport with a reduction in the ability to incorporate copper into certain enzymes that need it as a cofactor. The clinical phenotype stems from a deficiency of these enzymes, which explains the diversity of the symptoms. It begins in the first months of life with neurological disorders (hypotonia, seizures) and bone and vascular abnormalities. Usually, death occurs before the age of 5.

Acute leukemia is uncommon in neonates and has a much poorer prognosis than in older children. We report on a case of acute lymphoblastic leukemia observed in a neonate who had bleeding and hepatosplenomegaly at birth, which justified intensive care during the first postnatal week. Despite early appropriate treatment, the patient died at 7 months of age. We present here physical and laboratory findings, which indicate a grim prognosis. These criteria should be considered carefully in order to ensure a realistic information for the parents and appropriate decisions. (C) 2007 Elsevier Masson SAS. Tous droits reserves.

Acute leukemia is uncommon in neonates and has a much poorer prognosis than in older children. We report on a case of acute lymphoblastic leukemia observed in a neonate who had bleeding and hepatosplenomegaly at birth, which justified intensive care during the first postnatal week. Despite early appropriate treatment, the patient died at 7 months of age. We present here physical and laboratory findings, which indicate a grim prognosis. These criteria should be considered carefully in order to ensure a realistic information for the parents and appropriate decisions.

Aim: There are still not enough informations to propose guidelines about post-discharge nutrition. We evaluated growth and bone mineralisation in very low birth weight (VLBW) infants fed preterm formula (PF) or standard term formula (TF).