French Experience of 2009 A/H1N1v Influenza in Pregnant Women

BACKGROUND: The first reports on the pandemic influenza 2009 A/H1N1v from the USA, Mexico, and Australia indicated that this disease was associated with a high mortality in pregnant women. The aim of this study was to describe and compare the characteristics of severe critically ill and non-severe pregnant women with 2009 A/H1N1v-related illness in France. METHODOLOGY/PRINCIPAL FINDINGS: A national registry was created to screen pregnant women with laboratory-confirmed 2009 A/H1N1v influenza. Three hundred and fifteen patients from 46 French hospitals were included: 40 patients were admitted to intensive care units (severe outcomes), 111 were hospitalized in obstetric or medical wards (moderate outcomes), and 164 were outpatients (mild outcomes). The 2009 A/H1N1v influenza illness occurred during all pregnancy trimesters, but most women (54%), notably the severe patients (70%), were in the third trimester. Among the severe patients, twenty (50%) underwent mechanical ventilation, and eleven (28%) were treated with extracorporeal membrane oxygenation. Three women died from A/H1N1v influenza. We found a strong association between the development of a severe outcome and both co-existing illnesses (adjusted odds ratio [OR], 5.1; 95% confidence interval [CI], 2.2-11.8) and a delay in oseltamivir treatment after the onset of symptoms (>3 or 5 days) (adjusted OR, 4.8; 95% CI, 1.9-12.1 and 61.2, 95% CI; 14.4-261.3, respectively). Among the 140 deliveries after 22 weeks of gestation known to date, 19 neonates (14%) were admitted to a neonatal intensive care unit, mainly for preterm delivery, and two neonates died. None of these neonates developed 2009 A/H1N1v infection. CONCLUSIONS: This series confirms the high incidence of complications in pregnant women infected with pandemic A/H1N1v observed in other countries but depicts a lower overall maternal and neonatal mortality and morbidity than indicated in the USA or Australia. Moreover, our data demonstrate the benefit of early oseltamivir treatment in this specific population

Analyse médico-sociale de 102 cas d'enfants victimes d'une chute de grande hauteur pris en charge à l'hôpital Necker

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

A survey of blood transfusion practice in French speaking paediatric anaesthesiologists

International audienceBackground: There are so far no existing consensus guidelines regarding red blood cell transfusion during paediatric surgery and there is a little information regarding red blood cell transfusion policy among paediatric anaesthesiologists. Objectives: To determine the transfusion threshold and the volumes of packed red blood cell (PRBC) transfusion among French speaking paediatric anaesthesiologists. Materials and Methods: A questionnaire of case scenarios was sent to active members of the French Language Society of Pediatrics Anesthesiologists (ADARPEF). Results: Out of the 324 active members of the ADARPEF, 175 (54%) completed the questionnaire. The threshold for blood transfusion varied from 6 g.dl-1 to 12 g.dl-1 depending on the scenario. The haemoglobin threshold for blood transfusion and the volume of blood transfused vary among ADARPEF physicians, for the same class of patients. The median [95% CI] haemoglobin threshold for starting blood transfusion was 7.9 [6.9 - 8.9] g.dl-1, 7.3 [6.4 - 8.2] g.dl-1 and 8.1 [7.0 - 9.2] g.dl-1 in the pre-, intra- and post-operative phase respectively. The median [95% CI] PRBC volume transfused was 11.7 [6.6 - 16.8] ml.kg-1 and the mean haemoglobin target was 11.6±1.9 g.dl-1. Physicians ranked anaemia (99%), underlying medical conditions (95%), hemodynamic instability (89%), haemostasis disorder (86%) and sepsis (79%) as the most significant factors affecting their transfusion decisions. Most paediatric anaesthesiologists (89%) measure the haemoglobin level before PRBC transfusion. Conclusions: This survey identifies significant differences in transfusion practice patterns among paediatric anaesthesiologists with a median [95% CI] transfusion threshold of 7.6 [6.6 - 8.6] g.dl-1 and a median [95% CI] PRBC volume transfusion of 11.7 [16.8 - 6.6] ml.kg-1

Evaluation de l’efficacité de la simulation haute fidélité dans la prise en charge des troubles du rythme cardiaque chez l’enfant: étude pilote

peer reviewe

Intracerebral gene therapy in children with mucopolysaccharidosis type IIIB syndrome: an uncontrolled phase 1/2 clinical trial

Mucopolysaccharidosis type IIIB syndrome (also known as Sanfilippo type B syndrome) is a lysosomal storage disease resulting in progressive deterioration of cognitive acquisition after age 2-4 years. No treatment is available for the neurological manifestations of the disease. We sought to assess the safety and efficacy of a novel intracerebral gene therapy

Intracerebral gene therapy in children with metachromatic leukodystrophy: Results of a phase I/II trial

International audienc

ICU-hospitalized severe patients (n = 40).

<p>Values: N (%) unless stated otherwise.</p>†<p>Respiratory failure included moderate hypoxemia (in fourteen cases), acute lung injury with 200‡</p><p>Thrombotic microangiopathy.</p>¥<p>Homozygous sickle cell anemia and vaso-occlusive crisis with acute chest syndrome (in one case), asthma (in one case), mitral stenosis and pulmonary edema (in one case).</p><p>*Other included postpartum hemorrhage.</p>○<p>Pathological pulmonary imaging including interstitial syndrome (in nineteen cases), alveolar syndrome (in twenty-eight cases), and pleural effusion (in two cases).</p>¶<p>Secondary pulmonary infection included <i>Streptococcus pneumoniae</i> (in three cases) and <i>Streptococcus sp.</i>, <i>E. coli</i>, <i>Pseudomonas</i>, <i>Haemophilus</i>, <i>Klebsiella pneumoniae</i>, <i>Cytomegalovirus</i>, and <i>Aspergillus fumigatus</i> infections (in one case each).</p>◊<p>Cardiac failure included cardiac dysfunction (in eight cases), vasoplegia (in eight cases), short cardiac arrest (in two cases), and pericarditis (in four cases).</p>††<p>Neurologic failure included ischemic cerebro-vascular disease (in one case), critical illness neuromyopathy (in two cases), hallucinations (in one case), and psychomotor agitation (in one case).</p><p>**Other included immunoglobulins for the treatment of thrombotic microangiopathy.</p