Guy Cheron

LE DYSFONCTIONNEMENT NEONATAL ISOLE DU TRONC CEREBRAL

Background. - Brainstem dysfunction in newborns (BDN) is an association of symptoms originally described in the Pierre-Robin sequence. BDN is thought to result from a deficiency of the sucking and swallowing embryonic organization. Population and methods. - Between 1983 to 1993, 48 infants without cleft polate were referred for suck and swallow abnormalities. They were considered to have BDN because they presented three of the four following criteria: neonatal suck and swallow difficulties: pharyngeo-oesophageat uncoordination with abnormal oesophageal mutometria; upper airway obstruction, either clinically obvious or detected on laryngoscopy; vagal overactivity, either clinically obvious or detected during Holter recording with ocular compression. Results. - Among these 48 infants, 30 were affected with polymalformative syndrome often involving embryonic fields derived from the neural crest. Three infants had a conotruncal cardiac malformation and 15 had no associated malformation. These latter 15 infants presented with facial dysmorphic features including reciding chin, glossoptosis. U-shape polate and a vertical tongue. From birth or the first weeks of life, they had suck and swallow difficulties with various functional symptoms: slow babybottle intake, cough or velo-pharyngeal incoordination, upper airway obstruction or apparent life threatening events (ALTE). Diagnosis was confirmed by both clinical observation and three simple investigations namely: laryngoscopy, vesoplungeal monometria and Holter recording with ocular compression. Ten children were nasogastric tube or gastrostomy fed, one had a tracheostomy and one had a nightly O2 supplementation. While the overall functional prognosis was good whatever the initial symptoms. 50% of these children had mental retardation, most moderate. Conclusion. - Examination of short-term follow-up in these children has stressed that BDN requires a specific management of both nutritional and respiratory troubles. Finally, BDN should lead to the active search of an underlying polymalformative syndrome and to an accurate neurologic evalution.

Malaise du nourrisson

Abstract Etiological and pathogenetic basis of the management of apparent life-threatening events in infants. G. Cheron Apparent life-threatening events in an infant require: 1/ to determine the seriousness of the event; 2/ to identify its etiology; 3/ to evaluate the risk of recurrence and the need for appropriate preventive measures. Management mainly depends upon the determination of the etiology and the understanding of the pathogenetic mechanism. Gastroesophageal reflux is the main etiology. Therefore whenever symptoms of gastroesophageal reflux are present, this has to be considered as the first etiological hypothesis. Other etiologies will be searched for if orientating symptoms or anamnesis information is present, leading to specific investigations.

SFP-57 – Urgences – Conseils téléphoniques : amélioration des pratiques aux urgences pédiatriques

Objectif ameliorer la qualite de reponse aux demandes de conseils telephoniques par le personnel medical et soignant. Materiel et Methode Construction par analyse de la litterature et consensus professionnel d’algorithmes de reponse pour 8 motifs d’appel (fievre, diarrhee, douleur abdominale, vomissement, traumatisme crânien, cephalee, eruption et gene respiratoire). - Evaluation de la frequence d’utilisation, de la qualite d’application de ces algorithmes et de la satisfaction au decours de l’entretien telephonique de la personne qui repond. Celle-ci donne une note globale de 0 a 10 et precise si elle a un sentiment de securite dans la qualite de la reponse. Resultats Du 22/11/07 au 15/1/08, 795 appels sont notes. Un, deux ou trios algorithmes de reponse sont utilises dans 68 % des cas et 627 utilisations d’algorithmes sont analyses. Fievre, diarrhee, vomissements et gene respiratoire sont les motifs les plus frequents, representant 33,5 %, 19 %, 18 % et 12,5 % des appels. Les recommandations des algorithmes sont suivies dans 98 % des cas. La satisfaction est exprimee par une note superieure ou egale a 7 pour 91 % des 434 appels notes, avec un sentiment de securite dans la reponse pour 100 % des medecins et 97 % des soignants. Il n’y a pas de difference d’appreciation de la securite de la reponse selon le motif d’appel. Les motifs d’appel non traites par un algorithme sont tres divers. Les demandes de conseil sur l’administration d’un medicament (N = 21), les pleurs (N = 17) et les toux (N = 14) sont les moins rares. Il n’y a pas de difference significative du sentiment de securite que la reponse soit faite avec ou sans algorithme et ce quel que soit le statut medical ou soignant de la personne qui repond. Conclusion Les algorithmes mis en place pour guider la reponse aux demandes de conseil par telephone sont adaptes. Ils correspondent aux motifs les plus frequents d’appel et ils satisfont leurs utilisateurs quant a la qualite de leur reponse. La mise en place d’autres algorithmes ne parait pas necessaire car les autres motifs sont plus rares, trop varies et ne posent pas de probleme de securite de reponse aux soignants.

Traitement de l'insuffisance cardiaque aiguë du nourrisson

The treatment of congestive heart failure in infants must be etiological and symptomatic. Vasodilators, inotropic agents and diuretics are the main therapeutics used in the symptomatic treatment. Guidelines for the emergency treatment according to the main etiologies are presented.