Extremely premature infants: How does death in the delivery room influence mortality rates in two level 3 centers in France?

OBJECTIVES: Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates' place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU). METHODS: Retrospective observational study including all pregnancy terminations, stillbirths and live-born infants within a 22- to 26-week 0/6 gestational age range was registered by two French level 3 university centers between 2009 and 2013. The mortality rates were compared between the two centers according to two places of inclusion: either the delivery room or the NICU. RESULTS: A total of 344 infants were born at center A and 160 infants were born at center B. Among the live-born neonates, the rates of neonatal death were similar in center A (54/125, 43.2%) and center B (33/69, 47.8%; P=0.54). However, neonatal death occurred significantly more often in the delivery room at center A (31/54, 57.4%) than at center B (6/33, 18.2%; P<0.001). Finally, the neonatal death rate of live-born very preterm neonates admitted to the NICU was significantly lower in center A (25/94, 26.6%) than in center B (27/63, 42.9%; P=0.03). CONCLUSIONS: This study points out how the inclusion of deaths in the delivery room when comparing neonatal death rates can lead to a substantial bias in benchmarking studies. Center A and center B each endorsed one of the two models of preferential place of neonatal death (delivery room or NICU) detailed in European studies. The reasons behind the two different models and their impact on how parents perceive supporting their neonate need further investigation.

[Child aggression by dogs: a preliminary study of risk factors]. / Les agressions d'enfants par les chiens: étude préliminaire des facteurs de risque.

Dog bites in children, although a genuine problem, have as yet been little studied in France from the viewpoint of epidemiology. A detailed study of 184 bites leading to management in a rabies control centre provided preliminary data on individual characteristics and behaviors of the dogs and children, as well as on features of the environment (place and time) that seem to be specifically associated with dog attacks on children. Increased insight into these risk factors should prove useful for the preventive information of children, parents, and dog owners.

[Not Available]. / Relations intraspecifiques et interspecifiques chez le chien familier: aspects analogiques et differentiels des comportements d'exploration.

Recent ethological studies on the interactions between man and his pet dog, have shown different analogies bétween the behavioural mechanisms developed during intraspecific and interspecific proximal relationships. This study characterizes new analogies between sniffing, licking and rubbing behaviours of familiar dogs, directed towards the urban environment, their conspecific and their master. The results emphasize the importance of the synergic relation between the exploratory sniffing and tasting behaviours. Different hypothesis are put forward concerning the functions of these behaviours developped by dogs during their social interactions and their importance in relations between humans and animals.

Maternal tactile behaviour correlated with mother and newborn infant characteristics.

Filmed observations of spontaneous interactions between mothers and their newborn infants (N = 50) were used to quantify the occurrences, duration and frequency of maternal tactile behaviours (stroking, kissing, touching the clothes, etc.). The analysis of the data shows that these maternal behaviours vary from one mother to another according to the activities of the newborn infant (sleeping, arousal but not feeding, feeding) and to different biological (sex of the infant, birthweight) and social (socio-economic status of the mother) variables. These results would suggest discussion topics concerning the differences between the mother-infant interaction systems.

Children and their pet dogs : How they communicate.

The research of ethologists has provided a better understanding of the mechanisms, role and development of communication behaviour between young children and their peers. However, little is known about the communication systems between children and their pets. A study of these relational systems would be needed to understand how the child interacts with his whole environment. The present study is based on the analysis of video tapes filmed during spontaneous interactions between children from 2 to 5 years of age with their pet dog (N = 45) in their home environment. Inventories were made of the child and dog behaviours during these interactions. The results have shown the different dog behaviours induced by the child and the different child behaviours induced by the dog. The links between these behaviours and the variables which characterize both partners (age, sex, etc.) were treated by factor analysis of correspondences. These data are discussed in relation to the behavioural inventories of children and dogs with their peers and conspecifics.

[Mother's touching behavior with regard to the newborn infant: preliminary cases]. / Les comportements de toucher de la mère à l'égard du nouveau-né: observations préliminaires.

Filmed observations of spontaneous interactions between mothers and their newborn infants were used to quantify the maternal tactile behaviours. These behaviours were analysed in relation to the activity of the newborn infant and the different characteristics of the mother and the newborn infant.

[Auditory competence of the newborn infant with regard to specific and non-specific rhythms]. / Les compétences auditives du nouveau-né à l'égard de rythmes spécifiques et non spécifiques.

This study is based on the analysis of modifications in the heart-rate of newborn infants (n = 12) hearing heartbeats at 72 and 120 bpm and metronome beats at 45, 72 and 120 bpm. The results show a selective discrimination of these acoustic stimulations by the infant.

[Body contact between mother and her newborn infant. Possible effect of a prenatal variable]. / Les contacts corporels entre la mère et son nouveau-né. Influence possible d'une variable prénatale.

We have found by looking at films of the spontaneous interactions between 50 mothers and their newborn babies that mothers behave in regard to touching their infants with negative correlation between the number of days that separate the estimated date of delivery from the actual date of delivery. All the same, if one takes into account the activity of the newborn (feeding, being awake without feeding and being asleep) it is only when the newborn is asleep that this correlation is to be avoided. There are different psychological and bio-psychological factors that can explain this phenomenon.

New data on communication behaviour between the young child and his pet dog.

A systematic investigation of communication behaviour between 2-to-5 year old children and their pet dogs (N=18), from video films shot in the home, shows that children take the initiative in communication more often, and that they seek more body contact with their dog. Different characteristics of the children such as age, family size and different characteristics of the dog such as size and sex are significantly correlated (p<.01 or p<.05) with the quantity of communications and with the different types of child behaviour in relation to the dog (stroking, hitting, etcz.sfnc;). This preliminary report leads to suggestions for further investigations of the data.