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Biomedical subjects

J B Gouyon

Publications and source records attributed to J B Gouyon.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Epidemiology of viral nosocomial infections in pediatrics].

Nosocomial viral infections account for at least 5% of the total of NI and reach 23% in pediatric wards. The nosocomial infection (NI) incidence rate varies from 0.59 to 0.72 per 100 patients in pediatric wards. Many viruses have been associated with NI in pediatric wards. Rotavirus and respiratory syncytial virus (RSV) are the most frequent. Other viruses frequently identified are: calicivirus, adenovirus, astrovirus, influenza et para-influenza, rhinovirus and coronavirus. Asymptomatic infections occur frequently. The period of communicability varies and depends on the virus. It often begins before the clinical signs appear and ends after the healing. Viral shedding may be intermittent. Children and hospital environment and less frequently hospital staff are the main source for the virus. Poor handwashing results in direct spread to patient or self-inoculation even for respiratory viruses like RSV and rhinovirus. The main risk factors for NI are prolonged hospital stay, past history of prematurity and low age. Immunocompromised patients constitute a special high-risk group. Understaffing is also a risk factor. Minimal infective doses depend on the route of inoculation and the kind of virus. Low doses are for example sufficient for rotavirus, adenovirus and calicivirus. Viral inactivation is all the more easy when there is an envelope. Handwashing and appropriate isolation (technical and geographical) are the mainstay of prevention of viral NI. Vaccines are promising, especially for rotavirus.

Child↗
PubMed1999

[What are the current limits for prematurity?].

HIGH PREVALENCE: Over the last 15 years, there has been a 2-fold rise in the prevalence of early prematurity (birth before 33 weeks gestation) and very early prematurity (birth between 22 and 28 weeks gestation). More than 7000 infants weighing between 500 g and 1500 g are born alive each year. Survival rates above 50% at 25 weeks, 86% at 29 weeks and 96% at 32 weeks are reported. These infants have the same right to adapted care as any other person. Nevertheless, maternal risks and the fact that these early and very early premature infants account for less than 1% of all births and yet include 50% of all neonatal deaths and 50% of all sequelae. A multidisciplinary approach is crucial for women with a high risk of delivery before 27 weeks gestation. ASSESSING PROGNOSIS: These infants comprise a very heterogeneous group of patients. Their survival and prognosis depends on many different factors. Antenatal factors include gestational age, estimated fetal weight, presence or not of malformations or fetal hypotrophy, and premature rupture of the membranes. During the perinatal period, antenatal corticosteroid therapy, pre-birth referral to a maternity ward with a pediatric intensive care unit, and care and degree of baro-trauma at delivery are essential. The neonatal assessment may lead to discontinuing treatment in case of extensive neurological damage. OPTIMAL CARE: With optimal care, achieved with an organized perinatal network using well-defined criteria for maternal referral, it should be possible to save 650 more children each year and reduce the number of severe handicaps by 390 among infants born before 33 weeks gestation. PREVENTION: Considerable progress has been made in perinatology, but simple and effective preventive measures must not be overlooked: reduction in the number of multiple pregnancies, detection of socio-demographic risk factors, treatment of asymptomatic bacteriuria, early diagnosis of threatening premature birth.

Delivery, Obstetric↗
PubMed1999

[Agenesis of the corpus callosum: etiological and clinical aspects, diagnostic methods and prognosis].

Agenesis of the corpus callosum is a frequent congenital malformation with many etiologies and clinical features. It can occur as an isolated defect which is usually sporadic, it is frequently associated with other malformations, genetic syndromes and metabolic disorders. Ante- or postnatal diagnosis must be followed by a careful search for etiology, and it raises uncertain and difficult question with regard to pregnancy continuation and infant development.

Agenesis of Corpus Callosum↗
PubMed1999

[Current networks in perinatal care. From practice to theory...].

Perinatal care networks have been organized in a conventional way in six different French areas. This paper describes the four successive steps of this organization: description of the perinatal dysfunctions through survey(s), elaboration of medical recommendations, set up of a new organization, evaluation of the efficiency of the new organization.

Community Networks↗
PubMed1999

Protective effect of perindoprilat in the hypoxemia-induced renal dysfunction in the newborn rabbit.

The renal effects of acute hypoxemia and the ability of perindoprilat, a potent angiotensin-converting enzyme inhibitor, to prevent these effects were assessed in 31 anesthetized and mechanically ventilated newborn (5 to 8 d of age) rabbits. Renal blood flow (RBF) and GFR were determined by the clearances of para-aminohippuric acid and inulin, respectively. Each animal acted as its own control. In eight normoxemic rabbits (group 1), the i.v. infusion of saline did not change renal and hemodynamic functions. In eight additional rabbits, acute hypoxemia (PaO2= 40 mm Hg) induced a significant decrease in mean blood pressure (-8+/-2%), RBF (-36+/-3%), and GFR (-31+/-3%) and an increase in renal vascular resistance (+50+/-12%). A third group of newborn animals (n=7) was used to determine the renal effects of perindoprilat administration (20 microg/kg) under normoxemic conditions. RBF significantly increased (+15+/-2%) and renal vascular resistance significantly decreased (-15+/-3%), whereas GFR, mean blood pressure, and filtration fraction did not change significantly. In group 4 (n=7), perindoprilat infusion completely prevented the hypoxemia-induced alterations in GFR and renal vascular resistance and partially prevented the fall in RBF. These results demonstrate that angiotensin II modulates the renal immature microcirculation and that inhibition of its formation effectively prevents the hypoxemia-induced decrease in GFR.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

Urea removal by neonatal hemo(dia)filters in hyperazotemic rabbits.

OBJECTIVE: Comparison of three neonatal hemo(dia)filters (FH22, Gambro; Minifilter Plus, Amicon; Miniflow 10, Hospal) for removal of urea by venovenous hemofiltration (HF) and venovenous hemodiafiltration (HDF). DESIGN: Filters were successively used for HF with two different blood flows (Qb = 8.3 and 16.6 ml/ min) and for HDF with the two different blood flows and four dialysate flows (Qd = 0.5, 1.0, 2.0, and 3.0 l/h). SUBJECTS: 21 anesthetized adult New Zealand White rabbits infused with urea. MAIN RESULTS: Urea clearance was significantly increased by HDF compared to HF regardless of blood flow, dialysate flow, and the hemo (dia)filter type except in the FH22 group, when blood flow was high and dialysate flow was 0.5 or 1.0 l/h. The FH22 filter allowed the best urea clearance during HF at high blood flow. During the HDF procedures, the Miniflow 10 allowed the highest urea clearance regardless of blood flow and dialysate flow.

Analysis of Variance↗
PubMed1997

Salt depletion and dehydration in hypertensive preterm infants.

Three preterm infants presented with both severe or moderate arterial hypertension and dehydration due to increased water and sodium urinary excretion. In patient 1, water and sodium wasting were extremely severe and peaked at 575 ml/kg per day and 73 mEq/kg per day, respectively. In all infants, urinary water and sodium excretion dramatically decreased when hypertension resolved. The overall clinical data suggest a pressure natriuresis phenomenon.

Antihypertensive Agents↗
PubMed1997

Prevention of hypoxemia-induced renal dysfunction by perindoprilat in the rabbit.

The role of angiotensin II, a potent postglomerular vasoconstrictor, in the hypoxemia-induced renal changes is still controversial. The ability of perindoprilat, an angiotensin converting-enzyme inhibitor, to prevent the acute renal effects of hypoxemia was assessed in 22 anesthetized-ventilated rabbits. In 8 untreated rabbits, hypoxemia induced a significant drop in mean blood pressure (MBP) (-12 +/- 2%), glomerular filtration rate (GFR) (-16 +/- 3%) and renal blood flow (RBF) (-12 +/- 3%) with a concomittant increase in renal vascular resistance (RVR) (+18 +/- 5%) and urine flow rate (+33 +/- 14%), and without any changes in filtration fraction (FF) (-4 +/- 2%). This suggests the occurrence of glomerular vasoconstriction during the hypoxemic stress. In 7 normoxemic rabbits, intravenous perindoprilat (20 microg/kg) induced an increase in urine flow rate (+17 +/- 4%) and RBF (+17 +/- 4%), and a decrease in MBP (-6 +/- 1%), RVR (-14 +/- 3%) and FF (-11 +/- 2%) without a significant change in GFR. The drop in FF and the increase in RBF suggests preferential postglomerular vasodilatation. In 7 rabbits, perindoprilat prevented the occurence of the hypoxemia-induced changes in RBF and RVR without improving MBP. FF decreased significantly (-18 +/- 2%), while the drop in GFR (-7 +/- 2%) was partially blunted and the increase in urine flow rate (+25 +/- 9%) was confirmed. These results could be explained by the inhibition of the angiotensin-mediated efferent vasoconstriction and by the inhibition of bradykinin degradation by perindoprilat. These data confirm the ability of converting-enzyme inhibitors to prevent the renal hypoperfusion induced by acute hypoxemia.

Angiotensin II↗
PubMed1997

[Colloid osmotic pressure and neonatal respiratory distress syndrome].

BACKGROUND: The interest of studying colloid osmotic pressure (COP) in neonates is based on a possible relation between low COP and severity of neonatal respiratory distress. POPULATION AND METHODS: Because this relation has not been accurately established, COP was prospectively measured at birth in 84 infants: 35 with respiratory distress syndrome treated with mechanical ventilation (group RD+: GA = 34.5 +/- 3.5 weeks; BW = 2,190 +/- 830 g); 49 free of severe respiratory disease (group RD-: GA = 37.5 +/- 2.5 weeks; BW = 2,720 +/- 655 g). RESULTS: On day one after birth COP was significantly lower in the RD+ group (15.0 +/- 2.2 mmHg) as compared with that in the RD- group (17.9 +/- 2.5 mmHg), and was negatively correlated with mean oxygenation index (OI) on day one, with the highest OI over the first five days of life, and with total duration of oxygen support (P < 0.05). COP was significantly reduced in the neonates with systemic hypotension on day one (P < 0.05). CONCLUSIONS: These results confirm a correlation between COP at birth and incidence and severity of neonatal respiratory distress. The relationship between low COP and systemic hypotension suggests an important role of COP in the ability of maintaining volemia. This study stresses the strong relationship between water homeostasis and neonatal respiratory distress. Nevertheless, it does not allow to conclude that modifying COP is necessary to improve neonatal respiratory disease.

Birth Weight↗
PubMed1997

[Treatment of neonatal convulsions].

Three important measures are concommitantly recommended in the treatment of neonatal seizures. 1) The maintenance of vital functions by supplying oxygen and using mask ventilation in addition to cardiac monitoring and placing an intravenous line. 2) The search for an etiology through metabolic and infectious laboratory tests. In many cases this will lead to an etiological treatment. 3) The specific treatment of the seizures: intravenous or intrarectal diazepam is the first line treatment. Phenobarbital, then phenytoin and clonazepam are used when diazepam is unsuccessful. Indications and duration of a secondary prophylactic treatment are controversial and must be discussed on the basis of the electroencephalographic data and the risk factors for epileptic seizures during the neonatal period and at 3 months of age.

Anticonvulsants↗
PubMed1997

Intravenous nicardipine in hypertensive preterm infants.

Eight preterm infants were given intravenous nicardipine, a calcium channel blocker, to treat systemic hypertension (renal artery thrombosis (n = 3); dexamethasone for management of bronchopulmonary dysplasia (n = 2); unexplained (n = 3). Nicardipine doses ranged from 0.5 to 2.0 micrograms/kg/min and were given for three to 36 days (mean (SD) 15.9 (10.3) days). Systolic blood pressure had significantly decreased after 12 and 24 hours of nicardipine treatment (-17 (17)% and -21 (10)%, respectively). Diastolic blood pressure significantly decreased after 24 hours of treatment (-22 +/- 16%). The decrease in blood pressure remained significant over the subsequent days of treatment. No hypotension or other clinical side effects were observed. It is concluded that intravenous nicardipine could be a first line treatment for hypertension in preterm infants.

Calcium Channel Blockers↗
PubMed1997

Effects of cisapride on QTc interval in neonates.

AIM: Prospective survey of the effects of cisapride on QTc interval in neonates given cisapride. METHODS: QTc interval was determined just before and 2.9 (0.9) days after outset of the treatment in 49 neonates treated with cisapride between 1 August 1995 and 29 February 1996. RESULTS: Cisapride significantly increased QTc interval (p = 0.0001), and this was higher when birthweight or gestational age were lower. The prolongation of QTc interval above the arbitrary value of 0.450 (n = 7) was clinically asymptomatic and was significantly more common in the infants born with a gestational age < or = 33 weeks (n = 6). CONCLUSION: The findings indicate that cisapride accumulates in less mature neonates. Further pharmacokinetic studies are needed.

Cisapride↗