Pediatrie最新文献

Despite the screening campaigns for early detection of congenital dislocation of the hip, some cases continue to be diagnosed late. The main reason for the failure to diagnose this disorder at an early stage is still unclear. A dislocated or a dislocatable hip is not always apparent during the initial newborn screening examination, and repeated clinical examinations throughout the first 12 months are necessary in order to establish the presence or absence of this disorder. At birth, radiographs are usually normal and a systematic pelvic radiograph of the neonate has no place in neonatal screening. Sonography helps to detect hip pathology early. However, owing to the dynamic nature of the disorder, a single early non-selective ultrasound has proved to be too sensitive and to lack specificity. In the United States, failure to diagnose the congenital dislocation of the hip is the most common musculoskeletal cause of litigation brought against pediatricians. In Europe, the system of fault liability implicates an obligation of ability and means. Failure to diagnose or misdiagnosis is not a fault in itself as long as a complete history, careful physical examination and adequate and appropriate complementary examinations have been performed by an adequately trained physician. If congenital hip dislocation is recognized and treated early, most of the affected children will develop functionally and radiologically normal hips. The longer the dislocation remains untreated, the harder it is to relocate the hip and the higher the incidence of secondary acetabular dysplasia, necessitating surgical correction. However, early treatment is not always successful or without complication. Consequently, the damages due to late onset of the treatment are difficult to assess.(ABSTRACT TRUNCATED AT 250 WORDS)

The case of a 13 month-old-boy with visceral leishmaniasis acquired in Brittany, a region of France where leishmaniasis is not endemic, is presented. The mode of contamination remains unclear, although a transfusional origin through blood transfusions during the neonatal period appears the most likely.

Optimal treatment of bacterial meningitis raises three questions: which antibiotic? which dosage? which duration? The overall duration of antibiotherapy has been shortened since the last decade. If a short-course treatment shows similar efficacy and rate of relapse, unnecessary prolonged course of treatment exposes to increased cost, duration of hospitalization and secondary effects. From 1979, Gold et al in Toronto treated all uncomplicated cases of meningitis for seven days and obtained satisfactory results. The first randomized trials evaluating optimal duration of treatment in meningitis were performed in 1985 by Lin et al: they showed no difference in terms of efficacy and complications between conventional and short-term treatment. Current rules in meningococcal meningitis consist of seven days or less on therapy, and 7-10 days for pneumococcal or Haemophilus meningitis. The sequential follow-up of C-reactive protein (CRP) levels seems a useful tool for the management of bacterial meningitis.

The dead newborns and stillborns of a French department (Ille et Vilaine, préfecture: Rennes) were studied during a 3 year period by a multidisciplinary physician group. There were 128 newborns and 207 stillborns among whom autopsies were carried out in 90 (72%) and 107 (52%) respectively. The contribution of the autopsies to diagnosis was highly different in the two groups: 92% in newborns and 34% in the stillborns. In the stillborns, autopsy was only contributive when congenital malformations were observed, whereas it was not when the cause of the death was obstetrical. We conclude that an autopsy must be performed in all dead newborns and stillborns; however for stillborns complementary investigations must be added, particularly on the placenta.

A fifteen-month-old child was admitted with a week history of isolated fever. On CSF (Cerebral Spinal Fluid) examination, hyperproteinorachy, hyperglycorachy and hypochlorurachy were found. The diagnosis of tuberculosis meningitis was suspected but usual tests were unable to find Mycobacterium tuberculosis in CSF, urine and sputum. Only the Polymerase Chain Reaction detected the Mycobacterium tuberculosis genome in the CSF. A specific treatment was started immediately. Apyrexia was obtained within 2 days; the outcome was favorable, without sequelae.

Renal tubular acidosis represents a heterogenous group of disorders with various etiologies and mechanisms. The physiopathologic basis of each type of renal tubular acidosis is reviewed, focusing on the laboratory investigations necessary to define the nature of the hyperchloremic renal tubular acidosis. Clinically, the four types of renal tubular acidosis can be associated with complications such as osteomalacia, urolithiasis and failure to thrive. Very often, the chronic administration of alkali results in normal growth and development, and greatly reduces the risk of stone formation or nephrocalcinosis.

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). However, most prefer to control CSF sterilization after about 48 h of therapy. 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.