Biomedical subjects
Publications and source records attributed to M Dehan.
In 6 neonates over 7 days of life, comparison of maximum and residual serum concentrations of ceftriaxone after intra-venous or intra-muscular administration showed the bio-equivalence of both ways. In both cases a single daily injection obtained bacterial serum levels on most of the strains responsible for secondary bacterial infections in neonates.
Twelve premature newborns mechanically ventilated with high FiO2 for hyaline membrane disease were tested for SOD contents during their first two weeks of life. CuSOD and MnSOD were measured in plasma, platelets and red cells using a radioimmunology method. No correlation was found between FiO2 levels neither with CuSOD and MnSOD contents. Furthermore no correlation was found between the SOD contents, at birth, and the constitution of bronchopulmonary dysplasia (BPD). Our results don't prove any relationship between lack of SOD and BPD. BPD pathogeny is certainly plurifactorial. Other protecting systems against O2 toxicity are also known to play an important role.
Accidents related to blood transfusion have become rare in neonates, due to the application of very strict rules. The 8 reported cases of post-transfusion hemolysis occurred in prematures less than 32 weeks gestational age. Signs consisted of hemoglobinuria and/or severe jaundice. In some patients exchange-transfusion had to be performed. Immuno-hematologic, bacteriologic and technical investigations did not show the etiology of these accidents. No similar clinical reports were found in the literature. Some authors suggest a mechanical origin.
The authors report the case of a neonate who presented since birth with refractory hypoxemia, peripheral edemas, ascites and pleural effusions. The mother had been given indomethacin for the 10 preceding days, in order to avoid premature labour. Echocardiography showed a tricuspid valve dysfunction with important regurgitation in the neonate. Under symptomatic treatment, clinical symptoms disappeared within 10 days. Echocardiography was normal by age 3 months. The responsibility of administration of indomethacin to the mother is discussed.
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To detect the presence of meconium and blood, we determined coproporphyrin and hemoglobin in 78 amniotic fluid samples, classified according to their visual aspect as clear (n = 45) or meconium-stained (n = 33). Among the 33 samples visually judged as meconial, a comparison of the results of their biochemical analysis with the mean values for clear amniotic fluids showed that only five of the 33 were contaminated solely with meconium. Seven others were exclusively bloody, and 19 were meconial and bloody. In two, the contaminant was neither meconium nor blood. Evidently, when the fluid is brownish, simple visual examination does not suffice for distinguishing meconium from old blood or other pigments. We propose a simple, rapid, and reliable method for simultaneously measuring contamination with meconium or blood.
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The authors report a peculiar type of maternofetal Chlamydia trachomatis (CT) infection in a 34 week-premature neonate. The revealing sign was the occurrence, at age 11 days, of frequent apneas with bradycardia, needing mechanical ventilation associated with adapted antibiotic therapy for 14 days. Diagnosis was confirmed by the isolation of CT in tracheal secretions. Immediate evolution was favorable. Literature data are reviewed and a short epidemiological survey is reported.
Serum C Reactive Protein (CRP) levels were measured in 242 neonates in whom materno foetal infection were suspected. In the 68 neonates in whom infection was proven, CRP levels were greater than or equal to 10 mg/l in 46 cases (68%). In the 154 neonates who were not infected, CRP levels were less than 10 mg/l in 132 cases (86%). In the 20 not infected neonates with positive peripheral samples for the same organism, CRP levels were less than 10 mg/l in 20 cases (100%). From these data, sensibility and specificity of CRP test for neonatal infection were respectively 67.6% and 85.7%.
An immunological method to measure phosphatidylglycerol (PG) levels was studied in 48 neonates with respiratory distress, by comparing the results with the lecithin sphingomyelin ratio (L/S) and with radioclinical data. In hyaline membrane disease (HMD), PG suggested immaturity in 91% of cases, as did L/S in 78%. In 6 of 20 cases with respiratory distress (30%) from other causes, PG level was low, which allows for discussion on the significance of this biological criterion as opposed to radiological and clinical criteria. This method of PG determination appears to be a more sensitive and reliable measure of lung maturity than the L/S ratio.
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The ultrasonic detection of periventricular leukomalacia is described in two neonatal patients. Confirmation of this condition by CT and post mortem was obtained in one case. CT scan and further echography was positive in the other. Neither patient had evidence of an intracranial hemorrhage. It is suggested that echography is of value in the early diagnosis of this lesion which may be similar to intraparenchymal hemorrhage in its mechanism and prognosis.
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A double blind therapeutic trial of ethyl clofibrate as a preventive treatment of hyperbilirubinemia in preterm neonates was performed in neonates of gestational ages ranging between 31 and 36 weeks. Forty-six children were given the treatment and 43 a placebo. A single 100 mg/kg dose of ethyl clofibrate was administered orally, between the 24th and the 48th hour of life. Significant results in the treated neonates are as follows: a lesser intensity of jaundice from the 48th hour of treatment; a lesser need for repeated bilirubinemia assay for the control of evolution and a lesser use of phototherapy if the serum concentration of clofibric acid is above or equal to the 140 micrograms therapeutic level before the 24th hour of treatment. The analysis of results also shows that the therapeutic clofibric acid serum level is reduced in 66% of neonates of relatively high gestational ages (34-36 weeks) and in 33% only of neonates of lower gestational ages (31-33 weeks). This study, added to the previous therapeutic trial performed in at term neonates, shows the efficacy of clofibrate in the preventive treatment of hyperbilirubinemia in preterm neonates. Further studies will allow to define the exact dosage according to gestational age.
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