[Evaluation of the information given to parents during the planned preanaesthetic consultation in a paediatric hospital]. / Evaluation de l'information donnée aux parents en consultation préanesthésique programmée dans un hôpital pédiatrique.

INTRODUCTION: Information given to the parents of paediatric patients during the preanaesthetic consultation (CS) must be understandable. OBJECTIVE: We have studied the impact of this information given during CS. METHODS: Prospective study over four months with a questionnaire completed by parents after CS and before the hospitalization. The Sfar information booklet was given to the parents before CS. The study evaluated whether the information had been given ("have you received the information on...?"), understood ("Did you understand...?"), and if CS had influenced anxiety of parents/child; on four items of information, anesthetic risk, transfusion, postoperative pain, and anesthetic technique. The questionnaire noted also the parents sociocultural level (NSC), and if they had read the Sfar booklet. Statistical analysis (descriptive, uni-, multivariate), p<0.05. RESULTS: Four hundred questionnaires were distributed, 334 were analyzed. The information on the four items was considered to have been given in 75%, understood 72%, and to have diminished anxiety 68%. These results were not influenced by whether or not (88%) parents had read the Sfar booklet. How much information was given was a function of the physician giving the information. Elevated NSC and amount if information given improved comprehension optimized. Diminution of anxiety was when all four items were understood, CS was performed by a senior physician and the parent's NSC was high. DISCUSSION: Information better adapted to NSC may improve the quality of CS. The Sfar booklet does not contribute to parents understanding in this context.

["Audio 4": a simple and quick speech audiometry test for moderate hearing loss screening in four-year-old children]. / "Audio 4": un test vocal simple et rapide pour le dépistage des surdités moyennes des enfants à l'âge de quatre ans.

UNLABELLED: The need for repeated auditory screening throughout early childhood faces the obstacle of the lack of objective validated material. OBJECTIVES: The goal of this two-year prospective study was to create and validate frequency-based word/picture lists appropriate for four-year-olds. Words were chosen not on the basis of the acoustic frequency of phoneme production, but on frequencies corresponding to their optimal recognition. Responses thus were to predict pure-tone threshold curves. MATERIAL AND METHODS: First of all, the linguistics laboratory created lists. Next, we proceeded to validate the form of the test: this involved verifying that the words selected on the basis of their frequency characteristics were common and well-known to children of this age. During the first year of the study, the picture boards were tested in a hospital otolaryngology service (66 children) and in a public health service (500 children) and corrected. RESULTS: All of the words and pictures were known during the next year by 5088 children. The second step was the audiometric validation of the test in a paediatric otolaryngology service. We compared classification of normal and impaired ears according to tonal audiograms and according to "Audio 4": 360 children were tested. Results were the following ones: Se: 0.81, Sp: 0.96, PPV: 0.91, NPV: 0.93. "Audio 4" therefore allows for prediction of pure-tone curves. CONCLUSION: This gives us hope that, directly interpretable by physicians, Audio 4, a rapid test which is attractive to children, will be used in diagnostic paediatric examinations whenever necessary.

[Use of diazepam in the treatment of opioid neonatal abstinence syndrome]. / Traitement par le diazépam du syndrome de sevrage néonatal aux opiacés (23 cas).

INTRODUCTION: The fetal opiate exposure presents many risks for the newborn. One of the most important is the neonatal abstinence syndrome that associates neurological and digestive signs. In some cases the vital prognosis can be involved. The evaluation of the syndrome's severity is based on certificated scales. The mortality has been reduced by the improved management of these neonates. Diamorphine, phenobarbital, chlorpromazine and diazepam are the most currently used. However, there is no consensus on the treatment. The data concerning the treatment are controversial, especially for the use of diazepam. The aim of our study was to describe the effects of diazepam obtained in three different centers and to compare our results to those of the literature. POPULATION AND METHODS: Twenty-three neonates were included. They were all hospitalized for abstinence syndrome and treated by diazepam. The Finnegan scale was used to evaluate the symptom's severity and the effects of the diazepam. The principal evaluation criteria were the duration of treatment and hospitalization, the timing in recovery of birth weight and the percentage of birth weight loss. RESULTS: The average treatment duration was 7 days, the average hospitalization duration was 18 days, the birth weight was recovered at 10 days of life and the percentage of loss of birth weight was 6.5%. Diazepam treatment failed in only one case. No case of intense dehydration occurred. CONCLUSION: Due to the retrospective design of the study, the diazepam could not be compared to other drugs. Nevertheless, it argues against the "anti-diazepam" attitude. A controlled randomised prospective study is needed to evaluated the optimal therapeutic strategy.

[Neonatal resuscitation in the delivery room: educational process and evaluation]. / Réanimation du nouveau-né en salle de naissance : démarche pédagogique et évaluation.

Based upon a three necessities basis: public health, biological and medico-legal, this article presents the state of the art about teaching neonatal resuscitation in the delivery room. The educational process is present worldwide; main experiences are described. Evaluation of these actions varies in the literature. We analyze the evaluation of the process of the trained professionals, their satisfaction, the changes in their practices, their theoretical and practical levels, and the impact on newborns' health. We propose a few measures to make official this kind of teaching in France, with a certificate for instructors and trained professionals.

[Outcome at 2 years of very premature infants cared at the hospital of Cayenne in 1998]. / Devenir médicosocial à l'âge de 2 ans des grands prématurés pris en charge au centre hospitalier de Cayenne en 1998.

UNLABELLED: Perinatal mortality in French Guyana is twice as high as the national rates. Within a global project rallying all the people working around the birth, a catching up program benefited the neonatal unit of the Cayenne hospital in order to make up for the important lack of modern structures and means. OBJECTIVES: To establish some quality care for the less than 33 weeks preterm infants born in 1998, and to estimate the medical and familial future for these infants after they have reached 2 years of age. METHODS: All less than 33 weeks old infants born alive and admitted at the neonatology unit of the CHC were included in the study. The obstetrical and neonatal data were recorded from the medical files. A survey was conducted through a questionnaire including the familial and medical outcome and was led from december 1999 to july 2001. Results were analysed with Epi-info 6.0 software (CDC, Atlanta, USA). RESULTS: Eighty-eight infants issue from 78 pregnancies were included. Among them, 29 were transferred in utero and 12 were transferred after birth. The mothers' situations were mainly characterized by precariousness, a poor follow-up of the pregnancy (27% non-declared), a higher morbidity of their newborns. Neonatal results did not differ from national results from Epipage cohort in terms of gestational age (29.9 weeks), weight at birth (1411 g), mortality (90.9 alive when released from the hospital), morbidity, growth at 2. However, 26% were hypotrophic (15% in Epipage cohort) in relation with the 29% pregnancies complicated with hypertension. Four infants were suffering from acquisition retardation due to motor handicaps; 2 infants had severe socio-educative difficulties. The postnatal follow-up was mainly performed by the Mother and Children Health Centers. A third of medical exams were not recorded in the health book, sensory screening exams were not performed. The opening of a medicosocial actions center in 2001, will allow a prospective follow-up of this population. CONCLUSION: Early neonatal mortality decreased from 10.3 for 1000 births to 4.4 in 1998. This reflects the improvement of the new-born caring possibilities. However, an improvement of mortality rates will not be possible without a better pregnancy follow-up.

[Postnatal growth delay in 27 to 33 week premature infants: frequency and risk factors. Retrospective study of 161 cases]. / Retard de croissance postnatal du grand prématuré (27-33 SA): fréquence et facteurs de risque. Etude rétrospective à propos de 161 cas.

UNLABELLED: The optimization of the nutrition of very low birth weight premature neonates has become a major concern given the improvement in survival for these children. The goal of the recommended nutritional intakes is to reach a quantitative and qualitative growth similar to the in utero growth. The objectives of this study were to analyze the anthropometric data at birth and near term in a cohort of premature neonates with birth weight appropriate for gestational age and to try to determine risk factors of postnatal hypotrophy. POPULATION AND METHODS: We conducted a retrospective study over three years (1998-2001) in the neonatology unit of the Armand Trousseau Children's Hospital, Paris, France. The inclusion criteria was a gestational age under 33 weeks with birth weight appropriate for gestational age. Data were collected at admission, during hospitalisation and at discharge and a standardised form was filled for each child. We defined postnatal hypotrophy (PNH) as an hypotrophy at discharge (weight < 10(th) centile according to the Audipog reference curve) in neonates with birth weight appropriate for gestational age. RESULTS: One hundred and sixty one neonates were included. Eighty two had PNH. In univariate analysis, factors significantly associated with PNH were: birth weight, gestational age, length of hospitalisation, the occurrence of nosocomial infection, of enteropathy, preeclampsia, neonatal asphyxia and antenatal corticoid treatment. In multivariate analysis, risk factors of PNH were: low birth weight, low gestational age and the occurrence of nosocomial infection. CONCLUSION: Our study shows that half of the appropriate for gestational age premature neonates were hypotrophic near term. The causes may be various: nutrition is not optimal and intercurrent factors may play a major role such as nosocomial infection.

[Necrotizing enterocolitis and apnoeas-bradycardias of the preterm newborn]. / Entérocolite ulcéro-nécrosante et apnées-bradycardies du nouveau-né prématuré

UNLABELLED: We conducted a case control study during six and a half years with the objective to analyse the risk factors for NEC. POPULATION AND METHODS: All cases of confirmed NEC matched to controls for identical gestational age and period of hospitalization; apnoeas-bradycardias prospectively counted. RESULTS: Forty-five cases were compared to 89 controls. The isolated risk factors were: an intra-uterine growth retardation (OR = 3,65, 95% confidence interval [CI] 95%: 1,54-8,63); a birth weight < 1000 g (OR = 8,16, CI 95%: 1,17-56,62), compared to a weight >/= 1500 g; a triple antibiotherapy (OR = 6,15, CI 95%: 1,16-32,45); an umbilical venous catheterization (OR = 2,64, CI 95%: 1,09-6,44); a number of simple apnoeas-bradycardias >/= 3rd tercile (n = 27) (OR = 4,54, CI 95%: 1,29-15,93), or severe (stimulated or with hypoxia) apnoeas-bradycardias >/= 3rd tercile (n = 8) (OR = 6,15, CI 95%: 1,59-23,75); an haemoglobin level lower than the 1(st) tercile (95 g/L) (OR = 5,90, CI 95%: 1,20-20,13); and milk thickening by Gumilk (OR = 2,78, CI 95%: 1,11-6,90). CONCLUSION: In the present practices, anoxo-ischemic factors during the first week of life do not represent an important risk of NEC; a great vigilance must be exercised for indications of the triple antibiotherapy and the treatment of apnoeas-bradycardias.

[Medical, cognitive and affective status of four-year-old very premature babies without severe disability. A case-control study]. / Devenir médical, cognitif et affectif à l'âge de quatre ans des prématurés indemnes de handicap sévère. Etude prospective cas-témoins.

AIM: To determine cognitive performances and affective development of a cohort of very premature babies at the age of 4 years. POPULATION AND METHODS: Longitudinal case-control study. Newborns less than 33 weeks gestation were included from 1992 to 1994 and were matched with two full-term newborns. At 4 years of age, they have been evaluated for medical status, cognitive functions with the K-ABC test and affective condition with the PSA and Conners' tests. RESULTS: The preterm group was significantly different from the controls for: a smaller height, (P < 0.01), a lower socioeconomic level (P = 0.027), a lower nursery school level (44% versus 27,6%, P = 0.05), the incapacity to draw "a bonhomme" (55,3% versus 93%, P < 0.001), lower performances for the K-ABC and PSA tests, a pathologic Conners score (20.4% versus 2.4%, P < 0.001). Multivariate analysis by logistic regression showed a similar neuropsychological results: a lower score of K-ABC (< 80, P = 0.0006, odds-ratio = 33.2), and a lower social competence score of PSA (< 45, P = 0.004, odds-ratio = 35.9). CONCLUSION: Follow-up of premature babies is required, and measures to prevent or minimize cognitive and social disabilities are mandatory.

Incidence of postoperative nausea and vomiting in paediatric ambulatory surgery.

BACKGROUND: We performed a prospective descriptive study over a 5-month period to determine the incidence of postoperative nausea and vomiting (PONV) during the first 24 h following elective ambulatory paediatric surgery, excluding head and neck procedures. METHODS: Four hundred and seven patients, aged 15 days to 16 years, were analysed prospectively. RESULTS: The incidence of PONV was 9.4%, occurring most frequently during the first 3 h after anaesthesia and in hospital but rarely during the journey home. It was associated with age, previous history of PONV, tracheal intubation or use of the laryngeal mask airway (LMA trade mark ), controlled or manual ventilation, opioids and absence of oral intake of liquids or solids. Conversely, type of surgery, premedication, induction mode, association of regional anaesthesia, inhaled nitrous oxide, duration of anaesthesia, stay in the postanaesthesia care unit and duration of journey after discharge were not significantly associated with PONV. CONCLUSIONS: PONV never induced complications or delayed patient discharge and curative treatment was rapidly effective.

[Postoperative comfort in pediatric outpatient tonsillectomy]. / Evaluation du confort postopératoire après amygdalectomie en ambulatoire chez l'enfant.

OBJECTIVE: Evaluate the comfort in children after ambulatory tonsillectomy, disregarding the surgical technique and with a systematic prescription of paracetamol and codeine. The study lasted 4 days including the day of surgery. STUDY DESIGN: [corrected] Prospective study during 5 months. PATIENTS AND METHODS: We performed a prospective study over a five-month period to evaluate the comfort in children after ambulatory tonsillectomy. Opioids were used for analgesia during surgery, morphine and propacetamol in the recovery room, and a systematic prescription of paracetamol-codeine between Day 0 to Day 3 at home. The assessment of pain was made by nurses and the family, considering 6 endpoints: spontaneous pain and when swallowing by verbal scale (0 to 4), occurrence of PONV (0 or 1), quality of sleep (0 or 1), quality of feeding (0 or 1) and play (0 or 1), combined in a global score of 0 to 12, with a score < or = 4 very satisfactory. RESULTS: 78 children were included, 49 tonsillectomy by dissection, 29 by Sluder. The score were < or = 4 at Day 0 and Day 1 in 53 children, but statistical analysis (univariate analysis) showed difference between the two surgical procedures with a global comfort score better and PONV lower with dissection procedure. CONCLUSION: The use of paracetamol-codeine after tonsillectomy offers a reliable analgesia with very satisfactory scores of comfort. Such prescription is effective in ambulatory tonsillectomy if a rigorous selection of patients is made.

[Neonatal bacterial infection by maternal-fetal contamination: for a change in approach? 1. Detection of Streptococcus agalactiae infection: methods and evaluation of results]. / Infection bactérienne néonatale par contamination materno-foetale: pour un changement de paradigme? 1re partie: Dépistage de l'infection à Streptococcus agalactiae: modalités et bilan des effets.

Perinatal group B streptococcal infection has been the subject of numerous studies and despite guidelines established during the last decade remains a frequent disease with high mortality. The basic aim of the guidelines is to screen for Streptococcus agalactiae during the antepartum period in order to institute antibiotic therapy during delivery. A critical review of the literature highlights the real impact and adverse effect of these guidelines: difficult application (only two-thirds of all maternity units have a protocol and compliance is only 75%), maternal risks of antibiotic therapy (especially the emergence of resistant Gram negative bacteria), fetal risks (accentuation of neonatal sepsis with resistant strains, retarded neonatal infections, frequent use of antibiotics with a broader spectrum, higher frequency of nosocomial sepsis).

[Neonatal bacterial infection by maternal-fetal contamination: for a change in approach? 2. Uncertainties and proposals]. / Infection bactérienne néonatale par contamination materno-foetale: pour un changement de paradigme? 2e partie: Incertitudes et propositions.

Based on a critical analysis of the literature, it is clear that even though mortality has decreased to 10-15%, the prevalence of neonatal bacterial infections remains dramatically stable. Precise risk factors can be identified in most cases of neonatal infection, but remain uncertain in many others: Streptococcus agalactiae is found in only 40% of the cases of sepsis; Escherichia coli, Haemophilus influenzae, Pneumococcus, and group A Streptococcus strains should also be considered for a real prophylactic strategy; context (prematurity), lack of a consensual attitude for intrapartum strategies; management schemes for asymptomatic neonates. Based on these observations, we make proposals for a realistic attitude for everyday practice based on risk factors, maternal and neonatal bacterial sampling procedures, and modalities for neonatal antibiotic therapy.

[Medical informatics (hospital information systems) in neonatology: reality and insufficiencies]. / Information médicale (programme de médicalisation des systèmes d'information) en nèonatologie: actualités et insuffisances.

The generalized implementation in France of hospital information systems (HIS) is often considered by the medical practitioners as a useless constraint. Nevertheless, they are now largely used by the administrative authorities for their economical evaluation of medical care. In neonatology HIS is applied to the hospitalized sick neonates as well as to the healthy newborn infants during their maternity hospital stay with their mother following birth. This paper focuses on the practical aspects and difficulties of the current French HIS in neonatology.

[Diagnostic value of physical examination and electrocardiogram in the initial evaluation of heart murmurs in children]. / Valeur diagnostique de l'examen clinique et de l'électrocardiogramme dans l'évaluation initiale d'un souffle cardiaque de l'enfant.

OBJECTIVE: To investigate the diagnostic value of the physical examination and electrocardiogram in the evaluation of heart murmur in new patients referred to the pediatric cardiologist. METHOD: From 1 April to 30 September 1998, all consecutive patients referred to the pediatric cardiology clinic for evaluation of heart murmur were included. They were prospectively categorized with no heart disease, possible heart disease or definite heart disease based on history and physical examination. They then underwent electrocardiogram with which the diagnosis was reevaluated by the pediatric cardiologist. Lastly, a doppler-echocardiography was systematically performed. RESULTS: In 120 children aged four days to 14 years (median: ten months), 72 (60%) showed abnormalities on doppler-echocardiography and 48 (40%) no heart disease. After physical examination, 52 patients were categorized with no heart disease: 45 patients had a normal doppler-echocardiography; in three of them, the diagnosis was incorrectly modified to possible heart disease on the basis of the electrocardiogram. In the other seven children, the electrocardiogram was normal and the doppler-echocardiography revealed minor (n = 5) or moderate (n = 2) heart defects. Nineteen patients were suspected of having possible heart disease, no diagnosis was modified after analysis of the electrocardiogram and six had normal doppler-echocardiography; 49 patients were correctly diagnosed as having definite heart disease. The sensibility of the physical examination was 90.3%, the specificity was 93.8%, the positive predictive value 95.6% and the negative predictive value 86.5%. CONCLUSION: The electrocardiogram is of no help in the discrimination between heart disease and no heart disease in children referred to the pediatric cardiologist for a cardiac murmur. The physical examination is able to differentiate children with or without heart disease in most of the cases.

[Pediatric anesthesia practice in France: a survey of 1,526 anesthesiologists]. / Enquête sur la pratique de l'anesthésie pédiatrique en France auprès de 1,526 anesthésistes-réanimateurs.

OBJECTIVES: To assess the individual activity of anaesthetists in paediatric anaesthesia (PA), and collect their wishes about continuing education and recommendations in PA. STUDY DESIGN: Transversal, prospective study. METHODS: A questionnaire of 33 items, sent to 4,360 anaesthetists, spread over 15 health districts, working in a public or private institution. RESULTS: We gathered 1,526 replies (35%) of which 34% university hospitals, 32% public institutions and 31% private institutions. 943 physicians (63%) had no specific structure, and 1,119 (87%) considered a specialized nurse to be essential for PA. 1,127 physicians (74%) had undertaken a specific session during their formation. The practice of PA depends upon age and context. Above 1 year old, the surgery that is performed weekly was ENT (38%), abdominal and urologic surgery (28%). Mask induction was performed by 60% of the physicians in children under 5 years. 63% of the anaesthetists dreaded a laryngospasm during induction. 625 physicians undertook regional anaesthesia in children under 5 years (87% caudal anaesthesia, 48% peripheral nerve blocks). 1,029 physicians (67%) wished for recommendations in PA in children under 12 months. CONCLUSIONS: This survey showed that most of the anaesthetists wished for recommendations in their paediatric anaesthesia practice.

[Medical and psychological status of one-year-old premature babies without severe disability. Case-control prospective study]. / Devenir médical, psychologique et affectif à l'âge d'un an des prématurés indemnes de handicap sévère. Etude prospective cas-témoins.

BACKGROUND: This case-control prospective study was conducted to determine whether and how medical, psychological and affective development differs from premature to full-term newborns without severe disability. POPULATION AND METHODS: Newborns under or at 33 weeks gestation (W) were included from December 1992 to January 1994 and were matched with two controls. The same examiners evaluated each infant at the effective postnatal age of nine to ten months. RESULTS: Fifty premature babies (average gestational age [GA] = 30.7 W) were compared to 100 controls. The main problems were bronchopulmonary (P = 0.03) and sleep (P = 0.027) disorders. Motor disability was suspected in 9% of the cases and none control (P = 0.00003, OR = 3.44). By multivariate analysis, cases differed from the controls by infant-mother relation disturbances (OR = 13.3), motherhood anxiety (OR = 13.3), poor expressiveness (OR = 5.6), peripheral tonus anomalies (OR = 39.5) and sleep troubles (OR = 5.8). CONCLUSION: Premature newborns had risks for the child-mother relation but not for psychoaffective development disturbances.

[Does stopping of oral feeding favour the occurrence of auriculoventricular block in premature infants treated with diphemanil?]. / L'arrêt de l'alimentation orale favorise-t-il la survenue d'un bloc auriculoventriculaire chez les prématurés traités par diphémanil?

BACKGROUND: Bradycardia in preterm infants may require anticholinergic therapy (diphemanil methylsulphate). Such treatment may cause prolongation of QT interval and auriculoventricular block. CASE REPORTS: Three premature infants born before 34 weeks of gestational age were given 6-8 mg/kg/d diphemanil because they suffered from bradycardiac episodes. Aggravation and/or persistence of bradycardia required withdrawal of gavage feeding: heart block occurred within a few hours which subsided after cessation of diphemanil and oral refeeding. Diphemanil at progressive dosage was later introduced safely in two of these infants. CONCLUSION: The short interval of time between the oral feeding withdrawal and occurrence of heart block justified therapy be stopped or transiently reduced whenever oral feeding must be interrupted.

[Nutritional fetal rickets. A case report]. / Le rachitisme carentiel du foetus. A propus d'un cas.

We report the case of a newborn who showed typical signs of rickets at birth craniotabes and severe hypocalcemia. The diagnosis of fetal rickets was confirmed by radiography. Maternal deficiency was revealed by an excessively low vitamin D level. The multiparous Moroccan mother had suffered low back pain and paraesthesia for several years. She wore the veil and rarely left her home. Nutritional and vitamin D deficiency was demonstrated. We report this exceptional case to recall the importance of vitamin D in the development of fetal calcium supply, the prevention of gravid osteomalacia and the prevention of neonatal hypocalcemia. Vitamin D supplementation (ideally 1000 IU per day during the third trimester or at least one 100,000 IU dose at the sixth and eighth months or a single dose of 2 to 3,000,000 IU at the sixth month) should be the rule in pregnancy.

[Relations between anesthetists and general practitioners or pediatricians. Results of a cross sectional study among 2281 physicians with private practice]. / Relations des médecins anesthésistes-réanimateurs avec les médecins généralistes et les pédiatres. Résultats d'une étude transversale auprès de 2,281 médecins libéraux.

OBJECTIVE: To assess the relationship of anaesthetiologists (Anaes) with general practitioners (GP) and paediatricians (Paed), possessors of the medical files of children scheduled to undergo ambulatory anaesthesia and participating in postoperative surveillance. STUDY DESIGN: Cross-sectional prospective survey. PERSONS: GP and Paed treating children admitted in September 1994 at the paediatric clinic of the University hospital of Tours for ambulatory surgery. METHOD: Questionnaire including 11 items circulated to 2,181 GP and 100 Paed of the centre of France. RESULTS AND DISCUSSION: Replies were obtained from 1,053 GP (48%) and 64 Paed (64%). The experience of Anaesth in paediatric anaesthesia was the least important criterion for the choice of the clinic (for 67% of Paed and 44% of GP). The rate of contacts of Anaesth with GP and Paed was low (23% of GP and 38% of Paed). Informations concerning anaesthesia (26% of GP and 42% of Paed), or its complications (8% of GP and 8% of Paed) were scarce. The rules of ambulatory anaesthesia were better known by Paed (56%) than by GP (34%), unlike those for autotransfusion (45% of GP and 23% of Paed). A majority of GP (82%) and Paed (73%) would appreciate an anaesthetic report. Most of GP (86%) and Paed (83%) were in favour of more informations, mainly through continuing medical education, on these problems.