Revista de pediatrie, obstetrica si ginecologie. Pediatria最新文献

Of a total of 24 newborn with neonatal bacterial infectious syndrome (NBIS), in 157 (65.12%) the infection appeared immediately at birth. In the rest of 84, the clinical manifestations appeared in the first 4 days of life followed in decreasing order by systemic manifestation without location on pneumonia and bronchopneumonia were the most frequently diagnosed, an organ, septicemias and meningitis, infectious jaundice, etc. Two antibiotics were associated in the severe forms, and antiinfectious monotherapy was used in the milder ones. In the cases with unfavourable clinical evolution, the antiinfectious treatment was used. The severe forms of NBIS were among the most cases of death at this age. NBIS manifested, therefore, under various forms, imitating other noninfectious affections. During diagnosis, mother's anamnestic data, and very often the clinician's intuition were very important, before the bacteriologic corroboration.

Syndrome of Neonatal hepatitis and atresia of extrahepatic bile ducts are the most frequent causes of jaundice with conjugated bilirubin in the small infant. The neonatal hepatitis is diagnosed by its plurietiologic character, onset in the first 3 months, subacute or chronic, potentially cirrhogenous, evolution, conjugated hyperbilirubinemia and mainly, gigantocellular hepatic transformation--the essential characteristic of the diagnosis. Etiology of neonatal hepatitis has extremely diverse causes: infectious causes, genetic diseases of metabolism, toxic causes, post-hemolytic states, neonatal acute hepatic necroses, parenteral nutrition, chromosomal anomalies, familial syndromes, etc.; there exists also a form with nonspecific cause (idiopathic form). Practically, neonatal hepatitis might often be mistaken for atresia of the extrahepatic bile ducts. In the latter case, the temporization of the surgery (bilidigestive anastomosis) for more than 2 months of cholestasis evolution leads to the appearance of hepatic cirrhosis lesions. The authors analyze various clinical, biological and histopathological elements which permit the differentiation in due time of the two situations that require different therapeutic attitudes. Except for certain situations, which allow an etiologic treatment, the main therapeutic element (pathogenic) is corticotherapy and several additional measures. The paper concludes with appreciations on the evolution, prognosis and prophylaxis possibilities.

Acute purulent meningitis of the newborn and infant still raise difficult diagnosis problems due to the often misleading onset, and require an energetic and early intervention, adapted, as much as possible, to the etiologic aspects. The study reports on 90 cases of acute purulent meningitis in the newborn and infant, admitted to the pediatric ward of the Bistriţa County Hospital, for 6 years (1983-1988). The clinical and biological aspects were various, sometimes blurred by the antibiotic administration. The study of CSF was the only valuable and compulsory parameter for supporting the diagnosis of meningeal infection and its etiology. In 63.3% cases, the meningeal infection was secondary to a primary infectious focus. Living gram-negative bacilli had the most frequent etiology, both in the newborn and in the infant. Meningitis with nonspecific etiology still hold 45.5%, and the most useful therapy in this situation seemed to be ampicillin + gentamicin + Biseptol and ampicillin + chloramphenicol. The age of the newborn and infant, the male sex, the biologic defects, the type and virulence of the etiologic agent were favouring factors in the appearance and severe evolution of the meningeal infection. Mortality was of 18.8% and the early found sequelae 8.8%. The evolution was favourable, when the diagnosis was precocious and the therapeutic intervention was energetic.

The author report several topical aspects of etiopathogenesis in infantile apnea, on the basis of the literature data. The first part considers the pathogenesis of the apnea of the premature infant. The next section presents the pathogenic implications of the sleep in infantile apnea. The final part discusses the apnea-sudden and unexpected death relation.

The paper reports on three cases of congenital lobular emphysema with warning respiratory manifestations as early as infancy. Starting from the clinical picture of respiratory distress, the diagnosis was established radiologically. The authors discuss the etiopathogenic aspects of the disease and its clinical-radiological manifestations, with the decisive role of the radiological exploration in diagnosis. The extension of respiratory dysfunction and the possible complications determine the opportunity of surgery.

The paper reports on a case of infantile cortical hyperostosis (Caffey's disease) diagnosed on the basis of clinical and typical radiological data, and benign and without treatment suggestive evolution by leaps. The appearance of the disease in several members of the same family pleads for its hereditary character.

The authors followed the efficiency of product Macronil in association with the usual (antibiotic and symptomatic) treatments in acute, viral respiratory infections in 62 children, 0-5 years old, admitted into hospital. Besides the usual treatment (25 cases--control group) Macronil was administered in 37 cases (experimental group). A significant improvement was found in clinical evolution (duration of disease evolution, improvement of general state, good appetite, fever duration, increase in weight) of the experimental group versus the control group. An important reduction (twice) of the pharyngeal viral population appeared in the experimental group treated with Macronil. In the control group, the viral flora, remained, practically, the same after treatment.