[Parent satisfaction with the Loire Infant Follow-up Team (LIFT) premature and at-risk infant network in the Pays-de-la-Loire area (France)]. / Satisfaction des parents dans le réseau de suivi des prématurés et des enfants à risques « Grandir ensemble ¼ des Pays-de-la-Loire.

BACKGROUND: The Loire Infant Follow-up Team (LIFT) is a network for caring for premature infants whose gestational age is 34 WA or less and at-risk neonates in the Pays-de-la-Loire area in France. The network aims to screen for clinical anomalies early and to propose adapted care. Trained physicians follow the included children in a standardized manner at 3, 6, 9, 12, and 18 months and 2 years, with a specific examination by psychologists at 2 years. The aim of the study was to assess the satisfaction of the parents of the children followed. METHODS: To evaluate parent satisfaction, a questionnaire from the Consumer Satisfaction Survey (CSS) in its French version was sent to parents whose infants were 2 years old, stratifying on the presence of an anomaly. The questioner had 39 items, with 8 specific items on the network and 31 from the CSS. The questionnaire was mailed twice in September 2006. RESULTS: Out of 300 questionnaires mailed, 269 were returned (rate 89.7 %). The questionnaire was assessed using principal component analysis with 2 dimensions for the 30 items common to all children, one of which covered empathy with physicians and the other with the consulting psychologists at 2 years. The validity was good (Cronbach coefficient, 0.91). The answers to overall questions such as "We are satisfied with the care in the network" scored 16.1±0.7/20, with 90 % "totally agree" or "moderately agree" responses. The "The care is perfect" scored 14.6±0.7/20 with 78 % agreeing with the statement. The total score for 30 general questions was 14.6±3.1 (median, 14.9). The total score was lower for infants with anomalies: 13.7±3.3 versus 14.9±2.9 (P<0.01). The answers with a low score (<10) were given by 22 parents (8.2 %). There was no significant relation between the total score or the satisfaction score and neonatal events. CONCLUSION: A postal survey is helpful to know the views of parents on the follow-up of their infants. This good level of satisfaction seems to stem from the parents feeling they belong to the network, the quality of the relationships with personnel, and the doctors' empathy, as well as the number of contacts between parents and the network coordinator.

[Follow-up network for newborns at risk for handicap in a French region]. / Réseau de suivi des nouveau-nés à risque de développer un handicap. L'expérience du réseau de suivi régional << grandir ensemble en Pays de la Loire >>.

BACKGROUND AND OBJECTIVES: - Follow-up networks for newborns with a handicap risk need to be put into place downstream of the perinatal health networks. Such a network was implemented in the Pays de la Loire region in 2003. Our objective is to evaluate the feasibility and the capacity to detect infants with an incapacitating condition at nine months corrected age and the patents'satisfaction with such a network. MATERIAL AND METHODS: - A common tool based on the Amiel Tison assessment was set up. Infants included since 1(st) March 2003 and who were two years old corrected age on 1(st) September 2006 were taken into consideration. A satisfaction survey was conducted with the parents of infants showing normal development at two years old corrected age or with an abnormal neuromotor examination. RESULTS: - Amongst the 1339 infants included, 1185 (88.4 %) were seen at the age of two years: 7.3 % showed pathological development, 4.5 % infants showed suspect neuromotor examination. Cares were proposed for 11% of the infants followed, permitting cares from nine months old for 65 % of the infants considered as having a pathological development at the age of two years. DISCUSSION/CONCLUSION: - This follow-up network has fulfilled its initial goal: 2.2 % of newborn babies in the region were included, a low rate of lost for follow-up was observed. Moreover, this network has a relative good capacity for detection and early initiation of care. The application of the parents is important and their level of satisfaction appeared to be high. This experiment shows that regional follow-up networks can become reality, but their efficiency still needs to be improved.

[Neonatal death of a newborn twin]. / Le décès d'un jumeau en réanimation néonatale. La place que le psychiatre peut prendre.

In France, in 2001, 33,000 children were born from multiple pregnancies (4.2% of births). Lately, with the stimulated fertilization improvement, this number has strongly increased. These pregnancies are pretty often difficult and the hospitalizations of the twins (or other multiples) in a neonatal intensive care unit are more frequent than in a single pregnancy (48 vs. 5.3%). Newborn twin death leads the parents to face a tough mourning because of the surviving twin presence. The psychiatrist's function is crucial with the parents, the deceased child, the surviving child and the pediatric staff. Therefore, as much as possible, the psychiatrist (or the psychologist) has to gather and work through the confused feelings of the parents. Several splittings occur in this situation. Some of these splittings concern the medical staff, some others affect the children, the dead one and the living one, either rejected and disinvested or idealized and overprotected. The child psychiatrist is a preferred recipient for the different projections of the parents.The hospital staff as a whole has to understand their full significance and their important psychic sparing for the couple. As the deceased child, the psychiatrist may look bad and unsatisfying, for instance: "he doesn't answer as we would like", "he doesn't come up to the couple's expectations", "he doesn't talk enough", "he's leaving too soon", etc.In addition, the psychiatrist may be attacked as the representative of the pediatric staff, in order to preserve in a better way the others medical protagonists, still essential for the survival of the alive child. These parents are in mourning and the psychiatrist must help them in this process in order to improve the specific investment of the surviving child, the attachment and the communication with him.

[Gravely ill newborns (excluding greatly premature) in 1986 and 1995 in three deparments of Pays de la Loire]. / Les nouveau-nés gravement malades (grande prématurité exclue) en 1986 et en 1995 dans trois départements des Pays de la Loire.

AIM: Evaluation of the progress in the treatment of seriously ill newborn infants under hospital care over the nine-year period from 1986 to 1995 in three departments of the Pays de la Loire region in France. POPULATION AND METHODS: The category of seriously ill newborn infants included only infants born after at least 32 weeks of gestation and having a Cullen severity score higher than 2. The two groups of seriously ill newborn infants at risk in 1986 and 1995 were first compared to a control group of healthy newborn babies delivered during the same years. The two groups were then compared with each other. RESULTS: In 1986 and 1995, the numbers of births were respectively 32,876 and 29,446, and the numbers of seriously ill newborn infants under hospital care were respectively 307 and 245. However, between 1986 and 1995 the risk factors as well as the causes of morbidity had changed. The average period of hospitalization decreased by five days. The mortality rate dropped from 0.16% to 0.09% (P < 0.05) and the number of serious complications decreased from 0.07% to 0.03% (P < 0.05). CONCLUSION: The improvement in the care of seriously ill newborn infants between the two reference periods, 1986 and 1995, may be attributed not only to technical progress but also to a better organization of the perinatal care in our region.

[Fetal and neonatal mortality from 22 weeks of amenorrhea in the Loire area]. / La mortalité foetale et néonatale à partir de 22 semaines d'aménorrhée en Pays de la Loire.

BACKGROUND: The Pays de Loire has a low perinatal mortality indicators among French regions but this could be due to under-notification. OBJECTS: To explore this hypothesis we undertook a survey in order to identify all fetal and neonatal deaths occurring at a gestionnal age of 22 weeks or more. We also tried to examine and analyze the causes of death. METHODS: All maternity (26) and neonatal wards (5) in the region took part in the survey in 1995. Clinicians were asked to fill out a questionnaire for all deaths occurring from gestational age (GA) 22 weeks and/or concerning a birthweight of a least 500 g. Only perinatal deaths related to parents living in the Pays de Loire were included in the study. RESULTS: Two hundred and sixty seven perinatal deaths were identified out of a total 29,440 births (9.1 /1000). Eighty three (2.8 /1000) were termination of pregnancy for medical reasons, of which 82% were motivated by chromosomic illness. Ninety-nine stillbirths fell (3.4 /1000) into two GA periods: 24 to 27 weeks (20%) and 38 to 41 weeks (2%). The cause of stillbirths remained unknown in 50% of cases despite a post-mortem examination rate of 87%. There were 29 deaths (1 /1000) in the immediate per and post-partum, 40% of which occurred at GA 22 to 25 weeks. Another 38% occurred at GA 36 to 40 weeks and these were related to undectected malformations or infections. Neonatal and intensive care units reported 56 neonatal deaths (1.9 /1000). GA was under 33 weeks for 44% of them. Deaths were caused by usual complications of severe prematurity, neurologic diseases and malformations. Thirty-two percent of total deaths were not notified to the French Authority: 25% of deaths for termination of pregnancy for medical reasons and 7% for stillbirths and per and post partum deaths. CONCLUSION: This survey suggests that the Pays de Loire perinatal mortality indicators remained low compared with other French regions, even after adjustment for this under notification. This casts doubts on the validity of perinatal mortality monitoring based on official notifications. The cause may lie in the inadequacy of legislation of the particular circumstances of perinatal deaths.

[Insulin-like growth factor I (somatomedin C) in premature infants on total parenteral nutrition. Relations with nutritional status and protein-energy intakes]. / Insulin-like growth factor I (somatomédine C) chez le prématuré en nutrition parentérale exclusive. Relations avec l'état nutritionnel et les apports protido-énergétiques.

Insulin-like growth factor I (IGF I) is like prealbumin and transferrin a marker of nutritional status. Its level increases with gestational age. The levels of IGF I (96 times), transferrin (86 times) and prealbumin (69 times) were measured in blood samples from 26 premature infants aged 8 to 78 days (gestational age: 28 to 34 weeks, birth weight: 840 to 1,800 g). At the time of sampling, all the infants were on total parenteral nutrition (360 +/- 42 kJ/kg/day and 2.5 +/- 0.3 g of proteins/kg/day). The results were analysed with reference to anthropometric parameters (weight, height, head circumference, skinfolds and arm circumference). There was no correlation between plasma IGF I and anthropometric measurements. There were significant correlations between IGF I and transferrin (p less than 0.01), prealbumin (p less than 0.05), protein intake (p less than 0.01) an energy intake (p less than 0.05). Plasma IGF I increased at the end of the first week of parenteral nutrition in all the 5 infants having initial low values. The plasma IGF I was not correlated with the duration of parenteral nutrition in the 26 infants after the second week of nutrition. IGF I measurement is useful for evaluating the protein nutritional status of premature infants on total parenteral nutrition.

[Evaluation of perinatal policy. Result of a survey about birth in Pays de Loire]. / Evaluation d'une politique périnatale. Résultat d'une enquête sur la naissance en Pays de Loire.

A survey was undertaken in 3 French departments of the Pays de Loire from January 1, 1986 to December 31, 1986. Among the 32,876 neonate (NN) population, the authors studied the 2,753 NN who were hospitalized and a control group of 1,458 NN representative of the population of 30,123 NN who were not hospitalized. Socioeconomic patterns of mothers, of their pregnancies and deliveries were studied in both groups. The control group was compared with the data obtained in 1981 at the national level and in 1982 at the local level. This group was used as a reference for the study of hospitalized NN. Intrauterine growth retardation rate was 2.4%, prematurity rate 4.6% of live births, very premature rate (as defined by a gestational age less than 32 weeks) was 0.45% of births. Among the group of hospitalized NN, which represent 8.5% of the general population, the NN were regrouped according to Cullen's classification and their care load estimated according to the Omega score. Thus 2 subgroups were defined: the 2,298 ordinarily hospitalized (Cullen's classes I and II) and the 455 severely sick NN (classes III and IV) i.e. 1.3% of births. One third of the severely ill NN were very prematures. The 2 other thirds presented with respiratory (24%), infectious (24%), malformative (19%) or neurological (13%) diseases. Lengths of stay and Omega scores varied according to the causes for hospitalizations and were inversely correlated with gestational ages (p less than 0.001). Neonatal mortality was 3.3 p. 1,000 births and rate of stillbirths 6.5 p. 1,000.

[Neonatal lupus presenting as telangiectasic and atrophic lesions]. / Lupus néonatal révélé par des lésions télangiectasiques et atrophiques.

The authors report on a new case of neonatal lupus erythematosus, with an un-usual dermatological presentation: sequelar lesions of telangiectasias associated with areas of skin atrophy. They emphasize the diagnostic difficulties that can be encountered when the mother is symptom-free, and the uncertainties of long-term prognosis of these children.

[Severe manifestations of non-poliomyelitic enterovirus infections in newborn infants]. / Manifestations sévères des infections à entérovirus non poliomyélitiques chez le nouveau-né.

The authors report eight cases of severe neonatal infections with Coxsackie and Echo virus. Meningo-encephalitis, aseptic meningitis, myocarditis and sepsis-like state were the most frequent presenting conditions. A high mortality rate was associated with meningo-encephalitis and low birth weight.

[A prospective study of the efficacy of bacterial filters in preventing complications of central parenteral nutrition in the newborn infant]. / Etude prospective de l'efficacité des filtres antibactériens sur la prévention des complications de la nutrition parentérale centrale chez le nouveau-né.

To investigate the capacity of bacterial filters to prevent complications of the central venous nutrition in neonates, 100 percutaneous central catheters were placed in 94 neonates: 50 catheters was used with a bacterial filter and 50 without filter. No significant difference appeared between the 2 groups for the frequency of complications. Complications should be avoided with a rigorous technique in the maintenance.

[One complication can mask another: chance discovery of a rare lesion during screening for arthritis of the hip]. / Une complication peut en cacher une autre: découverte fortuite d'une lésion rare au décours d'une surveillance pour arthrite de hanche.

The authors report the case of a new born baby in whom at the fourth day of life, a severe hypocalcemia was discovered. An umbilical arterial catheterization was performed. The evolution was characterized by a staphylococcic septicemia with hip arthritis and partial immune deficit. The mid term survey of the joint status, allowed the unexpected discovery, during an examination held under general anesthesia, of a probable mycotic aneurysm, by abdominal palpation. The lesion was localized on the right common iliac artery and was successfully treated by resection; arterial continuity was possible without venous patch nor prosthesis.