J.M. Tréluyer

Cytochrome P-450 expression in sudden infant death syndrome.

In the human liver, the major rise of the cytochrome P-450 isoform content occurs during the first months following birth (e.g., the high vulnerability period to sudden infant death syndrome (SIDS), a syndrome frequently associated with viral infection and drug hypersensitivity. We examined the expression of individual P-450 isoforms in liver samples collected postmortem from SIDS infants and compared values with those of control adults and children of the same age suffering from various pathologies. Hepatic microsomes were prepared and examined for their content in total P-450, the level of individual isoforms (CYP1A2, CYP2E1, CYP4A, CYP3A, and CYP2C) determined with specific antibodies and for their enzymatic activities. Total RNA was extracted and probed with several CYP cDNAs and oligomers. The overall hepatic P-450 content was not modified in SIDS infants. Among cytochrome P-450 isoforms, only CYP2C was markedly increased. This rise resulted from an accumulation of RNA encoding CYP2C and was associated with a stimulation of diazepam demethylation. The precocious expression of CYP2C in SIDS could result in a higher production of epoxyeicosatrienoic acids in the neonate, believed to act as relaxant of pulmonary smooth muscles. Its consequence might be the induction of fatal apnea in SIDS.

Intravenous nicardipine in hypertensive children

Fourteen hypertensive patients hospitalized in a paediatric intensive care unit were studied to evaluate safety and hypotensive efficacy of intravenous nicardipine. Systolic and diastolic blood pressure significantly decreased 1 h after the beginning of the treatment (1 μg/kg per minute). Mean decrease in systolic blood pressure during the first 24 h was between 9.9% and 13.4% of the initial value. Mean lowering of diastolic blood pressure was between 16.7% and 25.6%. Nicardipine did not significantly affect heart rate with dose of 1 μg/kg per minute. No clinical side-effects were observed. Nicardipine could be a first line drug for the treatment of hypertension in paediatric intensive care units.

Paludisme grave de l’enfant en réanimationEnquête nationale 1990-1995

BACKGROUND Severe malaria is a frequent complication of Plasmodium falciparum infections. More than one million children die of malaria each year. MATERIAL AND METHODS A French survey was carried out on 15 cases admitted to pediatric intensive care units between 1990 and 1995. The aim of this work was to evaluate the occurrence, mortality, morbidity and treatment of severe malaria in French intensive care units. RESULTS All cases were imported from Africa except one case of airport malaria. Diagnosis of many of these cases was delayed. All cases were treated with quinine, and five children received a loading dose. One child died and one has neurological sequelae. DISCUSSION Despite improvement in management, the prognosis of severe malaria remains poor. With reference to the literature, we propose management of severe malaria, emphasizing the necessity of a rapid effect with a loading dose of quinine.Resume Le paludisme grave est une complication des infections a Plasmodium falciparum chez l’enfant. Plus d’un million d’enfants decedent de paludisme chaque annee dans le monde. Les pays temperes sont egalement concernes. Materiel et methodes. – L’objectif du travail etait d’effectuer une enquete retrospective sur la periode 1990–1995 parmi les centres francais de reanimation pediatrique afin d’apprecier la frequence, la mortalite, la morbidite et la prise en charge du paludisme grave. Resultats. – Quinze observations ont ete recensees. Tous les cas etaient importes d’Afrique, sauf un cas de paludisme d’aeroport. Des prodromes et un retard diagnostique etaient frequents. La quinine a ete utilisee pour tous les enfants. Cinq enfants ont recu une dose de charge. Un enfant est decede et un a des sequelles neurologiques. Discussion. – Malgre une amelioration de la prise en charge, la mortalite et la morbidite restent lourdes. A partir de ces observations et des donnees de la litterature, nous proposons un schema therapeutique en insistant sur la necessite de traiter rapidement avec une dose de charge de quinine.