[Use of antibiotics in neonatology].
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Biomedical subjects
Publications and source records attributed to J C Gabilan.
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Three babies with untreated galactosaemia presented with severe coliform infections in the first month of life. The frequency of coliform infections in untreated patients is emphasised. Galactosaemia should be considered in any baby with a severe coliform infection.
Five full term neonates presented with haematemeses on one of the first three days of life. All but one had been given vitamin K at birth. Two out of five had clotting abnormalities that suggested vitamin K deficiency. All had evidence of hiatus hernia and, on oesophagoscopy, had evidence of peptic oesophagitis. Bleeding is another complication of neonatal peptic oesophagitis.
Renal papillary necrosis was detected early by plasma and urine analyses in a neonate with the respiratory distress syndrome. The intravenous urogram demonstrated characteristic features of the condition. Initial symptoms were polyuria, urinary salt loss and haematuria, but the only residual abnormality was a mild defect in urinary concentrating ability.
The aim of this study of 100 newborns with respiratory distress in the first 24 hours was to evaluate the diagnostic reliability of sequential L/S ratio testing of the fluid retrieved through tracheal suctioning in identifying hyaline membrane disease and that of calculating the urinary meconial index (UMI) for the first mictions in identifying amniotic fluid aspiration. The L/S ratio was found to be low (< 2) during the first 3 days in 90% of the cases of hyaline membrane disease; this good correlation shows that the technique employed here can reliably be used to diagnose clinically and radiologically atypical forms of this disease (12%). The UMI was found to be abnormally elevated (> 1) in all the cases of severe meconial aspiration. This result implies that minor or atypical cases or those in which another disorder is associated can be diagnosed by the test. It is therefore proposed that the concurrent use of these two tests would improve the accuracy of the etiological diagnosis of respiratory distress in newborns.
In some newborns with vital distress, conventional umbilical artery catheterization cannot be performed: in our series, this occurred in 34 out of 248 attempts. In 28 of these 34 infants, catheterization succeeded when hypogastric cut-down of an artery was carried out. Two of the 6 failures were due to a minor complication at the time of the cut-down, while two others occurred in infants presenting a single umbilical artery. The usual cuse of failure of conventional catheterization is probably laceration of the artery wall and ensuing subintimal fistulas and perforation.
An infant with idiopathic arterial calcification is presented. The disease was diagnosed during the life of the patient as an aortogram demonstrated a stenosis of the left coronary artery and complete occlusion of the right coronary artery.
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Quadruplets born at 36 weeks gestation were severely hyponatraemic. The mother had been given a sodium deficient diet for the majority of pregnancy and she herself was also hyponatraemic with hyperaldosteronism. This patient illustrates the problems of sodium restriction during pregnancy and the need for its supervision.
Among a series of 98 newborns who experienced neonatal seizures, 20 of them were individualized for they illustrated a "new syndrome": "the seizures of the fifth day of life". These patients were born at term, their maternal and natal history was unremarkable. Seizures always began around the fifth day and most often constituted a real electro-clinical état de mal. EEG reveals alternating sharpened theta waves, a pattern which seems to be characteristic. Some 6 days later, children recovered completely. Further evolution appeared to be always favorable. Although etiological enquiry remained negative, many facts suggested a viral etiology. This syndrome is probably frequent as it was also observed in other neonatal units.
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Famialial defect of hepatic fructose-1,6-diphosphatase. Diagnosis was suspected in a male newborn since a brother was also concerned by the disease. The disease may be therefore diagnosed early, when the onset is neonatal. In the neonatal distress syndromes due to hereditery disorders of metabolism, a semiologic field may be isolated in which symptoms begin after an interval of short duration with hypoglycemia, hepatomegaly, lactic acidosis and ketosis ("enlarged liver hypoglycemia"). This possibility leads first to a symptomatic treatment of hypoglycemia and acidoketosis, then to the feeding with human milk and simple functional tests for the diagnostic approach.
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