Furlow Palatoplasty, Nasopharyngeal Size, and Sleep Oximetry.

OBJECTIVES: (1) To assess the evolution of prepalatoplasty sleep oximetry (PRESO) and postpalatoplasty sleep oximetry (POSSO) in cleft patients and (2) to evaluate the impact of the size of the nasopharynx on PRESO and POSSO values. STUDY DESIGN: Retrospective cohort study. PATIENTS AND METHODS: In 81 patients with cleft palate and/or cleft lip, the following data were prospectively collected: patient demographics and prepalatoplasty cleft palate measurements. All the patients had at least 1 PRESO and POSSO. A Kaplan-Meier curve was obtained from all the sleep oximetry results. Transverse nasopharyngeal area (TNA) pre- and postvalues were compared for each group with paired t tests, while analysis of variance was used to compare TNA pre- and postscores between the groups with a Bonferroni correction for multiple comparisons. RESULTS: POSSO results were normal or showed mild desaturations in most patients in the few weeks following palatoplasty. For the cohort, no statistically significant changes were found between PRESO and POSSO values. A 2-fold variation in the area of the TNA was found before palatoplasty within identical cleft malformation cases. No statistically significant association was found between the TNA or the a/30 - b1 parameter values and the sleep study scores. CONCLUSIONS: The patients with the smaller nasopharyngeal areas presented identical PRESO and POSSO results when compared to those with larger nasopharyngeal sizes. Future studies should address the possible association between prepalatoplasty and postpalatoplasty TNAs and the occurrence of velopharyngeal deficiency later in life.

Health care professionals' attitudes about pregnancy termination for different fetal anomalies.

BACKGROUND: Health care professionals (HCPs) may be involved in counselling women after an antenatal diagnosis of various fetal anomalies. Many pregnant women consider termination of pregnancy (TOP) after antenatal diagnosis of various fetal anomalies. Little is known, however, about the attitudes of HCPs regarding TOP for specific antenatal diagnoses. OBJECTIVE: To determine the attitudes and opinions of HCPs in maternal and child health regarding TOP for fetal anomalies of varying severity. METHODS: AN ANONYMOUS QUESTIONNAIRE WAS DISTRIBUTED TO FOUR GROUPS OF HCPS: obstetric residents; paediatric residents; delivery room nurses; and neonatal intensive care nurses. Respondents were asked about TOP if they or their spouse were to receive an antenatal diagnosis for five prenatally diagnosed conditions: trisomy 21; trisomy 18; cleft lip and palate; Turner syndrome; and hypoplastic left heart syndrome. RESULTS: Two hundred eighty HCPs answered the questionnaire (90% response rate). Ten per cent of respondents would not consider TOP under any of the circumstances described. Among those who would consider TOP, they were most likely to do so for trisomy 18 and least likely for cleft lip and palate, and fairly evenly divided among the remaining three conditions (hypoplastic left heart syndrome [65%], trisomy 21 [56%] and Turner syndrome [37%]). Paediatric residents were less likely to choose TOP than other groups and obstetrics residents were most likely. CONCLUSIONS: Attitudes of HCPs toward TOP vary according to prenatally identified condition and professional group. More rigorous analysis should be performed regarding the process of counselling and the impact of HCPs beliefs on parental decisions.

HISTORIQUE: Les professionnels de la santé (PS) peuvent conseiller les femmes après un diagnostic anténatal de diverses anomalies fœtales. De nombreuses femmes enceintes envisagent une interruption de grossesse (IdG) après un tel diagnostic. Cependant, on ne sait pas grand-chose des attitudes des PS au sujet des IdG suscitées par des diagnostics anténatals précis. OBJECTIF: Déterminer les attitudes et les opinions de PS qui s'occupent des soins mère-enfant au sujet des IdG suscitées par des anomalies fœtales de diverses gravités. MÉTHODOLOGIE: Les chercheurs ont distribué un questionnaire anonyme à quatre groupes de professionnels de la santé : résidents en obstétrique, résidents en pédiatrie, infirmières en salle d'accouchement et infirmières en soins intensifs néonatals. Ils ont demandé aux répondants s'ils opteraient pour une IdG après qu'eux ou leur conjointe eût reçu un diagnostic anténatal de l'une des cinq pathologies suivantes : trisomie 21, trisomie 18, fissure labiopalatine, syndrome de Turner et hypoplasie du cœur gauche. RÉSULTATS: Deux cent quatre-vingts PS ont répondu au questionnaire (taux de réponse de 90 %). Dix pour cent des répondants n'envisageraient une IdG dans aucune des situations décrites. Les autres étaient plus susceptibles d'y avoir recours en cas de trisomie 18, mais moins en cas de fissure labiopalatine, et ils se répartissaient plutôt également entre les trois autres pathologies (hypoplasie du cœur gauche, 65 %, trisomie 21, 56 %, et syndrome de Turner, 37 %). Les résidents en pédiatrie étaient moins susceptibles d'opter pour les IdG que les autres groupes. Les résidents en obstétrique étaient les plus susceptibles de faire ce choix. CONCLUSIONS: Les attitudes des PS envers l'IdG varient selon la pathologie diagnostiquée pendant la période prénatale et selon le groupe professionnel. Il faudrait effectuer une analyse plus rigoureuse du processus de conseils et des répercussions des convictions des PS sur les décisions parentales.

Relationship between site of training and residents' attitudes about neonatal resuscitation.

OBJECTIVE: To determine whether the attitudes of pediatric and obstetric residents concerning the resuscitation of extremely preterm infants, and their knowledge of outcomes, varies according to their center of training and its resuscitation practices. DESIGN: Anonymous questionnaire. SETTING: Four province of Quebec, Canada, university centers. PARTICIPANTS: A total of 165 pediatric and obstetric residents. INTERVENTIONS: Survey of attitudes about resuscitation of neonates born between 23 and 27 weeks of gestation, and knowledge of the prevalence of cerebral palsy in survivors. MAIN OUTCOME MEASURES: Proportion of residents who would resuscitate a depressed, very preterm infant, and the proportion who overestimated the prevalence of cerebral palsy. RESULTS: The percentage of residents who would resuscitate a depressed infant born at 24 weeks varied from 11% to 39% between centers, at 25 weeks between 26% and 69%, and at 26 weeks between 51% and 86%. At the center most likely to intervene for very immature infants, the greatest proportion of residents favored resuscitation at each gestational age. At the least interventionist center, the smallest proportion would resuscitate. The center of training was the only factor related to willingness to resuscitate at 24, 25, 26, and 27 weeks of gestation; not age, years of training, religion, sex, or parental status (whether the person surveyed has children). A total of 53% of residents thought the prevalence of cerebral palsy was 25% or 40% in this population. Residents with a more accurate knowledge of outcome were more likely to want to resuscitate very immature infants. CONCLUSION: Different treatment centers may develop their own ethos regarding resuscitation, which then shapes both the way the residents understand epidemiological data and how they make decisions.