Archives francaises de pediatrie最新文献

Background: Infants and young children with sickle cell anemia are at increased risk of infection with Haemophilus influenzae type b. This report describes the immunogenicity and safety of Haemophilus b conjugate vaccine in such children.

Population and methods: One hundred and eleven children aged 6 months-11 years (mean: 3.7 years) were studied. They belonged to a cohort of over 600 children in the Paris area that have sickle cell anemia. After parental consent, they were given one injection (intramuscularly or subcutaneously) of Haemophilus influenzae type b-tetanus toxoid conjugate vaccine (0.5 ml). Any adverse reactions during the following 3 days were noted. Titers of specific antibodies were measured just before injection, one month, and one year later.

Results: The vaccine was well tolerated, with only local reactions: erythematous reactions in 5 children and pain in 30. In the children aged 6 months-3 years, the mean antibody titers increased from 0.09 to 20.6 micrograms/ml, 1 month after the vaccination; in those aged 3-11 years, the mean titer increased from 0.44 to 56.86 micrograms/ml. One year after vaccination, the titers measured in 61 children were over 1 microgram/ml in 92% of children aged 6 months-3 years and in 100% of the older children.

Conclusion: This type of vaccine is immunogenic and well tolerated. Thus the vaccination schedule recommended for children with sickle cell anemia aged over 6 months is the same as that for normal children.

Background: Most handicapped newborns that are abandoned suffer from Down's syndrome. This report describes the frequency of the practice.

Population and methods: All children (95% less than 1 month old) born between 1985 and 1987 in Paris who were placed for adoption by approved agencies were included in this study. Sociofamilial, medical and psychological histories were collected.

Results: A total of 326 infants were abandoned during these 3 years. 38 (12%) of them had Down's syndrome. 25 of the 34 mothers were 30 years old or more. 23 of 27 infants had two known parents. 134 newborns with Down's syndrome were registered in Paris during this period. Thus 27.6% of the total number of Down's syndrome children were abandoned. 87.2% of the abandoned non-trisomic infants were adopted, versus 31.6% of those with Down's syndrome (10.5% died before adoption). The 19 children with Down's syndrome who were not adopted live in foster families.

Conclusion: 2/3 of the mothers who have abandoned their trisomic infant were less than 35 years old and had a middle-class background. Further studies are necessary to better understand the emotional context of abandonment.

Background: Tumors involving the inferior vena cava and cardiac cavities are rare in nephroblastoma. When they do occur, the standard treatment is primary surgery; but this is often technically difficult.

Case report: A 3 year-7-month-old girl was admitted because of an abdominal mass and signs of heart failure. Ultrasonography showed that this mass involved the right renal vein and the inferior vena cava including the right atrium. A CT scan showed no metastases. Echocardiography showed that the mass occupied two thirds of the right atrium and had blocked the tricuspid valve. The patient was given heparin (2 mg/kg/day), vincristine (1.5 mg/m2 on day 1) and actinomycin D (15 micrograms/kg on day 1 to 3). The heart failure disappeared and the abdominal mass decreased in volume. This improvement was confirmed by successive ultrasonographies. Chemotherapy was then completed and the patient was operated on six weeks later: right nephrectomy and removal of the cavoatrial tumoral thrombus. Pathological examination confirmed the nephroblastoma and the patient was given radiotherapy and chemotherapy for 28 weeks. She was also given aspirin for 17 weeks. Pulmonary metastases were detected 1 year after onset and were treated by a combination of surgery and chemotherapy. The patient is well 20 months after the onset of the disease.

Conclusion: Preoperative chemotherapy seems to be effective in nephroblastoma extending to cardiac cavities; it allows subsequent surgery and facilitates postoperative radiotherapy.

Background: Thrombus formation is one of the main complications of the catheterization used for total parenteral nutrition. Its location inside the right ventricle is exceptional. This paper describes such a case.

Case report: A boy was born at the gestational age of 35 weeks, weighing 2,640 g. He developed acute respiratory distress followed by prolonged diarrhea that required parenteral nutrition. A catheter was inserted into his right subclavian vein when he was aged 5 weeks. The patient developed septic shock with multi-visceral failure 8 days later. Blood cultures showed Staphylococcus aureus. Despite symptomatic therapy and antibiotics, the baby developed thrombosis of the superior vena cava with no right atrial thrombus, that required removal of the catheter. Angiography and Doppler echocardiography performed 2 and 3 weeks later showed a thrombus in the right ventricle that disappeared within 2 weeks after prolonged antibiotic and heparin therapy.

Conclusion: Repeated Doppler echocardiography is necessary to monitor prolonged total parenteral nutrition. Intracardiac thrombus can be detected; this is more frequently located in the atrium than in the ventricle.