[Assessment by a national survey of needs for NICU and intermediate NICU in France]. / Evaluation nationale des besoins en lits de réanimation et soins intensifs néonatals.

UNLABELLED: The setting up of the so-called "decrees on perinatal safety" on October 1998 has been associated with many difficulties which were apparently related to the lack of beds for intensive care units, special care units and neonatal medicine. This led to a national survey. OBJECTIVES: The aim of the survey was : (1) to collect the number of neonates requiring hospitalization in NICU and special care units over a 1-week period in metropolitan France and overseas departments and territories; (2) to assess the needs in equipments and care-givers. METHODS: The writs to be included in the survey were previously identified. Each day of hospitalization was classified as needing an intensive care unit, a special care unit or a neonatal unit. Then it was classified as well fitted or badly fitted. RESULTS: Two hundred and forty units (90% of the French units) from 204 hospitals participated in the survey and 3678 neonates were included and accumulated 17 583 days of hospitalization (NICU: 2728; special care: 5047; neonatal medicine: 9808). One thousand and five hundred and ninety hospitalization days did not fit well either with the technical level required by the neonate or/and with the location of the parents' home (9.2%): 23.1% in overseas departments and territories; 12% in metropolitan France. The main reasons for maladjustment were: a too high technical level: (59%); an insufficient technical level: (21%) (19 neonates could not be admitted in a NICU as they needed). The survey included 158 NICU and special care units. Taking into consideration the French law: the lack in equipment was: 294 ventilators, 231 cardio-respiratory monitors, 116 pulse oxymeters and 513 blood pressure monitors; 561 additional pediatricians were needed to allow a medical night duties including seven doctors in each NICU and each special care unit; 1878 additional nurses were also needed. Making the assumption that the mean occupation rate of the neonatal beds should be 70%, the needs were calculated for 1000 live births: metropolitan France: 0.76 (0.74; 0.78) in NICU; 1.45 (1.43-1.47) in special care units; overseas departments and territories: 2 (1.8-2.5) in NICU; 3.5 (3.2-3.8) in special care units. CONCLUSION: Finally, the main deficit was not related to the number of beds but to the equipment and number of care-givers. The status of overseas departments and territories was particularly worrying.

[Cesarean section in the Burgundy perinatal network: reasons for differences in the management of mothers]. / La césarienne au sein du réseau périnatal de Bourgogne: analyse des différences observées dans la prise en charge des mères.

OBJECTIVE: The aim of our study is to determine the relative risk of cesarean section at term induced by medical, organizational and personal factors in a regional healthcare network. PATIENTS AND METHODS: Our retrospective study covered all 17,062 full-term births, not including pre-birth transfers, in the 20 maternity hospitals of Burgundy in 2001. Statistical analysis was performed on the data collected, which was exhaustive and validated for all 18,278 births of our perinatal network. RESULTS: The percentage of cesarean sections performed at term was 16.4% (overall percentage of cesarean sections was 17.5%, equivalent to our national rate in 1998). But there was significant inverse relationship between the percentage of cesarean sections and the level of our maternity hospitals (17.4, 16.1 and 14.1% for types I, II, and III respectively). And 4 of our 20 establishments had a higher rate of ceasarean sections, with no medical justification. DISCUSSION AND CONCLUSIONS: Our study shows that for a pregnant woman at term, the simple fact of benefiting from care in such a maternity hospital corresponds to a risk factor for cesarean section (OR = 1.9), which is higher than IUGR (OR = 1.6) diabetes (OR = 1.6) or macrosomia (OR = 1.3). It also shows the feasibility of such an objective analysis of medical practices, providing that data collection is exhaustive and validated for the whole population of the perinatal network, and providing that it includes medical, organizational and personal factors.