Étude épidémiologique descriptive sur les déterminants de la transfusion de globules rouges en soins intensifs pédiatriques

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

Pandemic A/H1N1v influenza 2009 in hospitalized children: a multicenter Belgian survey

<p>Abstract</p> <p>Background</p> <p>During the 2009 influenza A/H1N1v pandemic, children were identified as a specific "at risk" group. We conducted a multicentric study to describe pattern of influenza A/H1N1v infection among hospitalized children in Brussels, Belgium.</p> <p>Methods</p> <p>From July 1, 2009, to January 31, 2010, we collected epidemiological and clinical data of all proven (positive H1N1v PCR) and probable (positive influenza A antigen or culture) pediatric cases of influenza A/H1N1v infections, hospitalized in four tertiary centers.</p> <p>Results</p> <p>During the epidemic period, an excess of 18% of pediatric outpatients and emergency department visits was registered. 215 children were hospitalized with proven/probable influenza A/H1N1v infection. Median age was 31 months. 47% had ≥ 1 comorbid conditions. Febrile respiratory illness was the most common presentation. 36% presented with initial gastrointestinal symptoms and 10% with neurological manifestations. 34% had pneumonia. Only 24% of the patients received oseltamivir but 57% received antibiotics. 10% of children were admitted to PICU, seven of whom with ARDS. Case fatality-rate was 5/215 (2%), concerning only children suffering from chronic neurological disorders. Children over 2 years of age showed a higher propensity to be admitted to PICU (16% vs 1%, p = 0.002) and a higher mortality rate (4% vs 0%, p = 0.06). Infants less than 3 months old showed a milder course of infection, with few respiratory and neurological complications.</p> <p>Conclusion</p> <p>Although influenza A/H1N1v infections were generally self-limited, pediatric burden of disease was significant. Compared to other countries experiencing different health care systems, our Belgian cohort was younger and received less frequently antiviral therapy; disease course and mortality were however similar.</p

Sildenafil therapy for neonatal and childhood pulmonary hypertensive vascular disease.

In children under 5 years of age with severe pulmonary hypertension, sildenafil therapy resulted in prolonged hemodynamic improvements without adverse effects. Sildenafil attenuated rebound pulmonary hypertension after withdrawal of inhaled nitric oxide

Meningitis with subdural empyema due to non-typhoid Salmonella in a 9-month-old girl

We report a case of a 9-month-old baby admitted to the hospital because of low-grade fever, focal seizures in a context of watery diarrhea for 14 days' duration. The patient workup revealed a mild neutrophilic pleocytosis on cerebrospinal fluid (46 cells/mul), a positive stool culture for Salmonella pomona sensitive to ceftriaxone and ciprofloxacin, and a subdural empyema (SDE) on the cerebral MRI. The child received an intravenous third-generation cephalosporin for 4 weeks which resulted in cure. This case highlights an unusual extra-intestinal complication of non-typhoid salmonella infection. Involvement of the central nervous system with non-typhoidal salmonellosis is an important complication that can result in significant morbidity if not recognized and treated promptly. A focal intra-cranial infection must be considered in the differential diagnosis of any child presenting with focal seizures and gastroenteritis due to Salmonella. Appropriate diagnostic imaging of the head (cerebral CT scan with contrast and/or MRI) is mandatory to exclude the presence of an intra-cranial complication, even in the presence of negative CSF culture for Salmonella. Subfrontal and subtemporal SDE are sometimes missed on axial CT scans and better appreciated on MRI. Non-surgical treatment of small subdural empyemas with prolonged intravenous antibiotic therapy is a therapeutic option

Fatores determinantes para o nascimento de neonatos de baixo peso internados pelo método canguru

Objetivou-se identificar os fatores determinantes para o nascimento de neonatos de baixo peso em uma maternidade pública em Teresina-PI. Trata-se de um estudo descritivo, com abordagem quantitativa que é parte integrante de um estudo maior intitulado “Ser mãe no método mãe canguru: um estudo fenomenológico”. A amostra foi constituída por 51 mulheres, cujos neonatos estavam internados pelo método canguru, entre maio a julho de 2014. Evidenciou-se que a maioria das mães participantes encontrava-se na faixa etária de 21-30 anos (47,1%), com percentual significativo de mulheres sem companheiro (88,2%) e com ensino fundamental incompleto (47,1%). No que se refere aos partos, 58,8% foram cesarianas. A idade gestacional mais prevalente foi entre 31 e 36 semanas (58,8%). Conclui-se como principais fatores determinantes para baixo peso em neonatos a falta do companheiro, baixa escolaridade, baixa renda e parto cirúrgico