The practice of the mental image tool for the training of hand hygiene with Hydro-alcoholics solutions: randomized trial.

INTRODUCTION: Mental image (or mental practice), a psychological representation of a task to be carried out, is a technique that could enhance skills in several areas areas including medicine. OBJECTIVE: To evaluate the practice of the mental image tool for the training of hand hygiene with Hydro-alcoholics solutions among students of DCEM2. METHODS: Randomized trial including DCEM2 students in Neonatology and Pediatrics at Charles Nicolle Hospital during the same period. Group1: group training in the mental image, Group 2 of reference. The assessment of student achievement was evaluated in terms of obtained scores. RESULTS: The total number of students was 37. The overall score in group 1 was 17.17 ± 3.82 versus 11.58 ± 4.05 in group 2, p <10 -3. The friction duration of hands in group 1 was 30.56 S ± 4.52S versus 24 ± 5.17 in group 2, p <10-3. CONCLUSION: Mental practice may be a time- and cost-effective strategy that improves hand hygiene with Hydro-alcoholics solutions.

[Epidemiology of domestic accidents of young children in Tunisia: impact of the training of health professionals on data collection quality]. / Epidémiologie des accidents domestiques du jeune enfant à Tunis : Impact de la formation des professionnels de santé sur la qualité de la collecte d'informations.

BACKGROUND: In Tunisia, several studies on domestic injuries have been carried out on children attending care facilities. Nevertheless,there is a lack of data on incidence and kinds of child domestic injuries amongst general population because of absence of a reliable data collect system. AIM: To estimate the incidence and kinds of domestic injuries through a prospective survey "here-there" within two cohorts of young children attending two mother and child protection centers (MCPC) in Tunis during the three first years of their life and to analyze the importance of health professional training in improving data collect. METHODS: A prospective study "here-there" was carried out on two cohorts of children in two mother and child protection centers (MCPC) between January 2007 and December 2009. Only children aged less than 3 months at their first contact with the centers were included and followed up until age of 3 years. In the MCPC2 (cohort2), health personnel have been trained on data collection importance related to child domestic accident and asked to monitor accidents by calling parents while a phone line got available for this aim. In the MCPC1, health personnel was asked to work as they used to do and to collect data on child domestic injuries when children attend the center. RESULTS: 192/435 domestic accidents were recorded within cohort 2 vs only 1/686 within cohort 1. Annual incidence rate was 14.7% for the cohort 2. The kinds of accidents were: falls 78.2% (falls from high plans 84.6%), injuries15.1% (injury by cutting things 58.6%),burns 5.7% (burns by hot liquid 54.5%), intoxications 1%. In terms of damages, we recorded 4 cases of broken bones (thighbone, elbow,handwrist), stitches in 11 cases, broken teeth in 3 cases and nail pulled out in one case. No death was recorded. Training impact on accident prevention was not studied. CONCLUSION: Child domestic accidents are relatively frequent. Health personnel training allows to improve data. The kinds of recorded accidents indicate the need to educate parents on best practices towards strengthening prevention.

[Outcome at 2 years of very premature infants. A Tunisian series]. / Devenir neurologique à l'âge de 2 ans des grands prématurés. Série Tunisienne.

BACKGROUND: Neurodevelopmental outcome of very premature infant can be associated with a high rate of cerebral palsy. AIM: To assess the impact of very preterm birth on neurological outcome at the age of two years. METHODS: Retrospective study of all cases of very premature infants born at less than 33 weeks of gestational age, during the years 2005 to 2007. Neurodevelopmental outcome is reported. RESULTS: During the study period, the very premature infant rate was 1.5 %. A complete information about neurological outcome at the age of two years, was obtained in 60 cases.Eight infants (13.4%) showed major handicap (cerebral palsy) and four others infants developed neurosensoriel difficulties. CONCLUSION: The incidence of neurosensoriel handicap in our population seems relatively high. A strong effort must be made for identification of risk factors of neurodevelopmental disability.

[Evaluation of materno-foetal infectious risk after isolated premature rupture of membranes in at term new-born]. / Évaluation du risque d'infection materno-foetale après rupture prématurée des membranes isolée chez le nouveau-né à terme.

BACKGROUND: Premature rupture of membranes (PROM) is defined as rupture of membranes occurring before the onset of labor. It complicates 5 to 10 % of pregnancies. It continues to be a major cause of morbidity and mortality in the newborn. AIM: To evaluate infectious risk associated with PROM in at term and asymptomatic new-born and to study this risk according to the duration of rupture. METHODS: Retrospective study in neonatal unit of Charles Nicolle hospital of Tunis including all cases with isolated PROM in at term new-born during the year 2007. RESULTS: 299 cases were identified over 3749 live births that is an incidence of 8 %, divided to: 21 cases (7 %) between 6 and 12 hours, 86 cases (28.8 %) between 12 and 18 hours, 61 cases (20.4 %) between 18 and 24 hours and 131 cases (43.8 %) more than 24 hours. Diagnosis of colonization was reported in 54 % of cases when PROM occurred between 12 and 18 hours versus respectively 27.3%, 0 % and 18 % in respectively subset of 6 to 12 hours, 18 to 24 hours and more than 24 hours (p=0,03). 62 % of foeto-maternel infections were reported in subset of PROM more than 24 hours and 13.8 % in the subset between 18 and 24 hours. CONCLUSION: Our study emphasizes the important risk of foetomaternel infection associated with isolated PROM. This risk is major when the rupture exceed 12 hours but the limit of 18 hours can unrecognized some cases of probable foeto-maternel infection.

[Neonatal respiratory morbidity after elective cesarean section at term]. / Morbidité respiratoire néonatale après césarienne elective a terme.

BACKGROUND: Incidence of elective caesareans at term is increasing these last decades with an associated increase of neonatal respiratory morbidity. AIM: To analyse the influence of elective Caesarean delivery at term on the incidence of neonatal respiratory distress in order to propose an effective strategy of prevention. METHODS: It is an analytical study compiling all births resulting from elective Caesarean at term (gestational age ranging between 37 and 41+6 GA), reported over two years period at the Charles Nicolle hospital (Tunis-Tunisia). We compared 250 live births, without maternal risk factors, delivered by elective Caesarean to 250 births delivered by vaginal way. RESULTS: Frequency of the elective Caesarean at term was of 3.6% live births; it was mainly indicated in the presence of a cicatricial uterus. The incidence of respiratory morbidity was 6% (15/250) in the group exposed to the elective caesarean versus 1.6% (4/250 cas) in the reference group, OR=3.9; 95%CI: [1, 28-11, 99] p<0.01. Before the term of 39 GA, OR=5.22; 95%CI: [1.14-23.87] p=0.01. After 39 GA, the risk of respiratory distress decreased: OR=1.86 95%CI: [0.30, 11.35] NS. The principal etiology of respiratory distress in the exposed group was the transitory tachypnea of the newborn. CONCLUSION: Incidence of respiratory distress was higher at newborn babies born from elective Caesarean with a significant reduction in this incidence after the term of 39 GA.

Determinants of neonatal mortality in a Tunisian population.

BACKGROUND: In Tunisia, perinatal mortality remains a public health problem, currently estimated at 28 per thousand, including 15 per thousand of still birth rate and 10 to 15 per thousand of early neonatal mortality rate. The recent investigations show that about half of the deaths at less than five-years-old are of perinatal origin and that neonatal mortality represents two thirds of infant mortality. Published data regarding neonatal mortality and the causes of death are sparse. THE AIM: to evaluate the neonatal mortality rate over a 2 year period in our population study and to present data collected prospectively on the risk factors and the causes of all neonatal deaths. METHODS: A prospective cohort compiling all live births reported between January 2007 and December 2008 at Charles Nicolle hospital (Tunis-Tunisia). All the neonatal deaths that occurred before or after discharge or transferred to other hospitals and subsequently died are included. Births from termination of pregnancy were excluded from all the analyses. Causes of deaths were assigned according the International Classification of Diseases, Tenth Revision (ICD10). RESULTS: 88 neonatal deaths were recorded over 7285 live births (LB) that is a NMR of 12 per thousand LB. Early neonatal death occurred in 79 cases (88.7%), that is an ENMR of 10.8 per thousand LB. Risk factors directly related to neonatal mortality were prematurity (aOR=6.03- 95%CI: [2-18.13] p=0.001), neonatal respiratory distress (aOR=16.12 - 95%CI: [5.67-45.78] p<10(-3)), perinatal asphyxia (aOR=11.49 - 95%CI: [3.68-35.92] p<10(-3)), nosocomial infection aOR=8.71- 95%CI: [1.77-42.70] p=0.008, and small for gestational age aOR=7.11 - 95%CI: [2.23-22.69] p=0.001. 80.6% of underlying causes and 88.6% of immediate causes of death are gathered in the chapter "Certain conditions originating in the perinatal period". Maternal hypertensive disorders and extreme immaturity due to spontaneous prematurity were respectively responsible for 13.6% and 10.2% of underlying causes of neonatal death. CONCLUSION: Neonatal mortality remains high, dominated by the conditions originating in the perinatal period. The multitude of the risk factors implies the need for a multidisciplinary strategy of intervention, engaging the pre and perinatal prevention.

[Early-onset neonatal bacterial infections: a retrospective series of 144 cases]. / L'infection materno-foetale bactérienne: etude rétrospective a propos de 144 cas.

BACKGROUND: Early-onset neonatal bacterial infections continue to be a major cause of morbidity and mortality in the newborn. THE AIM of this study was to determine the incidene, the risk factors and bacterial epidemiology of these infections. METHODS: All cases of early-onset neonatal bacterial infections were identified for the years 2001-2003 using data from obstetric and neonatal reports at the neonatal unit of Charles Nicolle Hospital. RESULTS: 144 cases were identified over 11,201 live births, that is an incidence of 12.85 per thousand, of which 22 cases of sepsis infections. 22.9% of all newborns were premature and 18% had a low birth weight. Membrane rupture occurred more than 12 hours before delivery in 63.2% of cases and an intra-partum fever in 57.7% of cases. Half of newborns were symptomatic with a mean age of 7.5 hours at onset of symptomatology. The principal etiologic agents were Group B Streptococcus (GBS) and Escherichia coli (E.coli), responsible respectively of 50% and 29.1% of proved infections. GBS had been recognised as the most prevalent agent in term newborn (58.9%) and the E.coli in premature newborn (38.5%). The neonatal mortality before discharge was 2.77% of all cases. CONCLUSION: Neonatal bacterial infections continue to be a major cause of morbidity in the newborn. The most common etiologic agents remain GBS and E. coli.

[Neonatal mortality and morbidity in newborn newborns of single mothers]. / Morbidite et mortalite des nouveau-nés issus de mères célibataires.

BACKGROUND: Newborns of single mothers constitute a high risk population for intra-uterine growth retardation (IUGR) and neonatal mortality. AIM: Our study analysed the influence of this socio-economic factor on neonatal mortality and morbidity. METHODS: A retrospective cohort compiling all births resulting from illegitimate pregnancies reported between January 2001 and December 2003 at the Charles Nicolle hospital (Tunis-Tunisia) "IG = illegimate group" (n=75), apparied for mothers gestity, parity and age, to 75 legitimate births "LG=legitimate group" reported after or before each illegitimate birth. RESULTS: The mean age for mothers in the "IG" was 24.3 years. The mean of prenatal consultations was 0.5 in the "IG" vs. 5.2 in the "LG" (p < 0.001). Delivery by caesarean section was of 6.7% in the "IG" vs. 18.7% in the "LG" (p = 0.049). Prematurity was observed in 17% in the "IG" vs. 8% in "LG". IUGR was observed in 29% of "IG" vs. 4% in "LG" (p < 0.001). Neonatal mortality was of 4.1% in "IG" vs. 1.3% in "LG". CONCLUSION: These results indicate the importance of illegitimate pregnancies as a demographic risk factor of neonatal morbidity. The IUGR was the most significant risk factor associated to illegitimate pregnancies.