Service de reanimation pediatrique

Bron, France

Service de reanimation pediatrique

Bron, France
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Batouche D.D.,Service de Reanimation Pediatrique | Kerboua K.,Service d'Immunologie
Current Pediatric Research | Year: 2016

Introduction: Acute renal failure (ARF) is a rare pediatric disease. Despite significant advances in the methods of treatment, still the disease presents high mortality rates. Objective: The aim of the study was to analyze the prognostic factors that determine the rates of morbidity and mortality among children suffering with acute renal failure and admitted to Paediatric Intensive Care Units in Oran (Algeria) Patients and methods: A retrospective study was conducted of the data obtained from the Pediatric Intensive Care Unit of the University Hospital of Oran. The prognostic factors associated with ARF were recorded for of 260 patients over a period of 20 years. The parameters that were noted at the time of admission of ICU patients are: age, sex, clinical severity, underlying diseases, type and ARF mechanism, diuresis, the time to onset of ARF (ARF early: 1 to 2 days, late ARF: 3 days), the concentration of creatinine, use of mechanical ventilation, associated organ failure, diuretics administration, the use of positive inotropes, the need for renal replacement therapy (RRT), outcomes of the treatment and follow-up data of one year. All these data were collected and analyzed statistically. PRISM score and pediatric RIFLE criteria at the time of admission were used to characterize the patients. Results: The mean age of pediatric patients was 77.261 ± 4.401 months. ARF was diagnosed in 38% of the patients at the time of admission while 61.5% acquired it in the hospital. Renal replacement therapy was administered in 63% of the cases. The overall mortality was 24%. The results of Univariate analysis revealed significant association of the clinical score severity at admission (p=0.0025), oligo anuria (p=0.0043), age<12 months, creatine at admission (p=0.0017), more than two organ failure and vasopressives drugs (p=0.0037). Interestingly, mortality was found to be associated with the PRISM score at baseline (RR: 2.1 [CI: 1.5 to 6.8], sepsis complicated by more than two organ failure (RR: 17.25 [CI: 2.8 to 33.9]; p=0.002) and age less than 1 year. Conclusion: The findings of the present study highlight the most relevant prognostic factors associated with occurrence of morbidity or mortality in pediatric ARF patients. Further clinical studies should be conducted for the application of these parameters as prognostic factors in future recommendations. © 2016, Scientific Publishers of India. All rights reserved.

Boudry G.,French National Institute for Agricultural Research | Jamin A.,French National Institute for Agricultural Research | Chatelais L.,Pole medico chirurgical de pEdiatrie et de genetique clinique | Gras-Le Guen C.,Service de reanimation pediatrique | And 2 more authors.
Journal of Nutrition | Year: 2013

The interplay between the colonic microbiota and gut epithelial and immune cells during the neonatal period, which establishes the structure of the microbiota and programs mucosal immunity, is affected by the diet. We hypothesized that protein-enriched milk formula would disturb this interplay through greater flux of protein entering the colon, with consequences later in life. Piglets were fed from postnatal day (PND) 2 to 28 either a normal-protein formula (NP; 51 g protein/L) or high-protein formula (HP; 77 g protein/L) and weaned at PND28, when they received standard diets until PND160. HP feeding transiently increased the quantity of protein entering the colon (PND7) but did not change the microbiota composition at PND28, except for a higher production of branched-chain fatty acids (BCFAs) in an in vitro fermentation test (P < 0.05). HP piglets had greater colonic mucosa densities of cluster of differentiation (CD) 3+ and CD172+ cells and lower II-1β and Tnfα mRNA levels at PND28 (P < 0.05). Later in life (PND160), HP females, but not males, had a higher increase in colonic permeability after ex vivo oxidative stress and higher cytokine secretion in response to lipopolysaccharide in colonic explant cultures than NP females (P < 0.05). HP females also had lower colonic amounts of F. prausnitzii and BCFAs (P < 0.05). BCFAs displayed a dose-dependent protection against inflammation-induced alteration of barrier function in Caco-2 cells (P < 0.05). In conclusion, protein-enriched formula had little impact on colonicmicrobiota, but it modified colonic immune cell development and had a long-term effect on adult colonic mucosa sensitivity to inflammatory insults, probably through microbiotal and hormonal factors. © 2013 American Society for Nutrition.

Leclerc F.,Service de reanimation pediatrique | Vamecq J.,French Institute of Health and Medical Research
Archives de Pediatrie | Year: 2015

Lactate production results from anaerobic glycolysis. This pathway is recruited physiologically during intense and sustained muscular contractions. Hyperlactatemia may develop when tissue oxygenation is jeopardized such as in shock, its absence having been, however, sometimes reported in sepsis in which interactions between infectious agents and the organism's cells might blunt or disrupt hyperlactatemia development. During the course of acute rotavirus gastroenteritis, a 9-month-old girl developed severe dehydration (capillary-refill time, 5s) leading to hypovolemic shock without signs of sepsis and with hypotension at 62/21. mmHg Surprisingly, the child failed to develop hyperlactatemia during shock. An etiologic search to understand why hyperlactatemia did not occur revealed that this patient had been receiving propranolol since the age of four months for the treatment of a Cyrano hemangioma. Via its inhibitory action on β-adrenergic receptors, propranolol antagonizes the stimulation of glycolysis by catecholamines, which may be rationally proposed to have contributed to preventing hyperlactatemia during hypovolemic shock in this patient. Mechanisms by which propranolol can mediate this antihyperlactatemia action are further illustrated and discussed. © 2014 Elsevier Masson SAS.

Quenot J.-P.,Service de Reanimation Medicale | Milesi C.,Service de Reanimation Pediatrique | Cravoisy A.,Nancy University Hospital Center | Capellier G.,Besancon University Hospital Center | And 3 more authors.
Annals of Intensive Care | Year: 2012

Critically ill adult patients often require multiple examinations in the hospital and need transport from one department to another, or even between hospitals. However, to date, no guidelines exist regarding optimum practices for transport of these fragile patients. We present recommendations for intrahospital transport of critically ill patients, excluding newborns, developed by an expert group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), the Société Française d'Anesthésie et de Réanimation (SFAR), and the Société Française de Médecine d'Urgence (SFMU). The recommendations cover five fields of application: epidemiology of adverse events; equipment, monitoring, and maintenance; preparation of patient before transport; human resources and training for caregivers involved in transport processes; and guidelines for planning, structure, and traceability of transport processes. © 2012 Quenot et al.

Introduction - The objective of the SERAC study was to describe the long term handicaps in children severely injured and admitted in intensive care after a road accident. Methods - Children severely injured (Injury severity score, ISS>16) admitted to a paediatric intensive care unit in 2003 and 2004 among 12 French pediatric intensive care units (PICU) were included. A clinical and neuropsychological assessment using standardized and validated scales was performed six months and 12 month after the accident. Results - Among the 139 children included, 31 deceased. Median age was 9 years and median ISS was 27. Among the 108 survivors 89 and 88 were assessed at 6 months and 12 months respectively. Somatic complaints the most frequently reported were fatigue (70%), attention disorders (>60%), behavioural disorders (60%). According to the type of handicap assessed, 25 to 40% of children were disabled. Most of them returned to their previous school, but 20% had difficulties. Familial consequences of these disabilities were frequent and long lasting. Conclusion - The frequency of symptoms reported by parents differed from those of impairments and disabilities assessed by tests. These handicaps had a link with the severity of traumatic brain injury and had a significant impact on family.

Butin M.,Service de Nephrologie | Mekki Y.,Laboratoire Of Virologie Est | Phan A.,Service de Nephrologie | Billaud G.,Laboratoire Of Virologie Est | And 4 more authors.
Pediatric Infectious Disease Journal | Year: 2013

We report a case of an immunocompetent child who developed parvovirus B19 infection complicated by autoinflammatory disease with myocarditis, tamponade and macrophage activation syndrome. He recovered with immunotherapy including prednisone, immunoglobulins, cyclosporin and anakinra (anti-interleukin-1). The report shows that parvovirus can provoke severe systemic inflammation with acute heart injury and that anti-interleukin-1 might be considered in such parvovirus-related inflammation. Copyright © 2013 Lippincott Williams & Wilkins.

BACKGROUND: Extrapulmonary complications of Mycoplasma pneumoniae infection are rare and dominated by nervous system disorders. Two patients suffering from acute disseminated encephalomyelitis associated with M. Pneumoniae infection are reported. AIM: Report of two new cases CASES REPORT: The 2 cases, M. Pneumoniae infection was documented by the positivity of serology, polymerase chain reaction and culture in the respiratory tract. Patient 1 recovered after prolonged mechanical ventilation in the paediatric intensive care unit. He was fully conscious 1 month after admission and able to walk with help 2.5 months after the onset of the disease. The 2nd patient died after 9 days of hospitalisation in the intensive care unit. The death was caused by neurovegetative disorders.

Koehl B.,Service de Reanimation Pediatrique | Oualha M.,Service de Reanimation Pediatrique | Lesage F.,Service de Reanimation Pediatrique | Rambaud C.,Service dAnatomopathologie | And 4 more authors.
Pediatric Infectious Disease Journal | Year: 2012

We report 2 cases of previously healthy children, who developed, after a common parvovirus B19 infection, a sudden inflammatory response, involving predominantly T cell, directed against myocardium and leading to fatal outcome. These cases and several published case reports further our understanding of fulminating parvovirus myocarditis in children. © 2012 by Lippincott Williams & Wilkins.

Riffard G.,Service de Reeducation Fonctionnelle | Trapes L.,Service de Reanimation Pediatrique
Motricite Cerebrale | Year: 2015

Acute respiratory failure in severe disabled people is a frequent and serious complication with a high morbidity and mortality rate. Common management relies on antibiotic therapy combined with clearance of airway secretions. Several manual and instrumental airway clearance techniques can be used to improve patients and tend to avoid mechanical ventilation, which is a controversial ethical issue. Postural changes should be associated with these techniques to decrease muscular contraction and enhance alveolar recruitment. This article is an overview of the most useful airway clearance techniques in disabled patients. © 2015 Elsevier Masson SAS. All rights reserved.

Ben Hamadi D.,Service de Reanimation Pediatrique | Calvet C.,Service de Reanimation Pediatrique
Soins Pediatrie/Puericulture | Year: 2015

Summary Invasive procedures are frequent and painful in children treated in paediatric haematology. It is therefore essential to take into consideration and anticipate the pain induced by these procedures. The caregiver has various effective methods of providing a high quality care management.

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