[Memory boxes in the neonatal period: caregivers' opinions after 1 year of practice]. / Coffrets de souvenirs en réanimation néonatale et pédiatrique : ressenti des soignants un an après leur mise en place.

UNLABELLED: Perinatal death is a profound experience for childbearing families and mementoes are key to providing essential records of the baby's life and death. The aim of this observational study was to evaluate the caregiver's feelings on 1 year of using memory boxes in the neonatal and pediatric intensive care unit of a tertiary care center. METHOD: Anonymous survey containing 14 questions. RESULTS: During the study period, a memory box was made for 31 neonates (24 preterm and 7 term infants) and 4 infants. Thirty-nine (54%; 32/62 nurses; 7/12 physicians) answers were obtained. Caregivers considered that memory boxes: i) were appropriate for death in the neonatal period (80-92%) or for infants who had never returned home (80%), ii) helped parents in their grieving process (77%), and iii) helped caregivers to support parents respecting their spirituality and emotional needs (62%). Some restrictions were mentioned such as the symbolic impact of the box mimicking a coffin and the modeling clay used for footprints recalling children's toys (10%) and the possibility of hurting parents in their religious convictions (18%) or feelings (20%). For the majority of the caregivers, memory boxes were considered helpful for families (82%); a few thought they were helpful for the ICU team (26%). CONCLUSIONS: This is the first study describing caregivers' opinions about the memory box practices. Memory boxes are considered helpful for bereaved parents, especially in the neonatal period, but are of little help to the caregivers.

[Noninvasive mechanical ventilation in paediatric intensive care units: which indications in 2010?]. / Ventilation non invasive en réanimation pédiatrique : quelles indications en 2010 ?

Noninvasive ventilation (NVI) is increasingly used in paediatrics, although there is a high variety of practices and a paucity of published data in paediatrics. The last French consensus conference recognized a specific role of NVI for infants suffering from acute bronchiolitis with apnoea, and acute respiratory failure due to laryngotracheomalacia and cystic fibrosis. NVI is feasible and can be beneficial in paediatric acute respiratory failure during neuromuscular diseases. Like in adults, its place in other diseases such as acute bronchoalveolitis without apnoea, acute respiratory failure during neuromuscular diseases, status asthmaticus, acute respiratory distress syndrome (ARDS) and postextubation respiratory failure is growing, even though not always defined. All these adult recommendations have not been validated in the pediatric setting, and, thus, taking the paediatric characteristics into account is essential. In 2010, NVI had an important place in PICU, and must be managed by a trained team whose practice is regularly evaluated.

[Evaluation of the French neonatologists' attitude towards the birth of an infant at less than 26 weeks' gestation]. / Évaluation de l'attitude des néonatologues français face à la naissance d'un prématuré d'âge gestationnel inférieur à 26 semaines d'aménorrhée.

UNLABELLED: Resuscitation of infants who are born at the threshold of viability remains highly controversial. The purpose of our study was to evaluate the French neonatologists' attitude toward the birth of an infant at less than 26 weeks' gestation (WG). METHOD: This article reports the results of a survey sent by the Internet to one of the neonatologists in each of the NICUs in France. The answers showed the different attitudes at the time of the birth of an extremely premature infant born less than 26 WG. RESULTS: The respondents represented 57 % of the original sample. None resuscitates an infant born between 22 WG+0 days and 22 WG+6 days. During the 23rd WG, the majority answer (90 %) was "Resuscitation is never undertaken". During the 24th WG, the main answer (29 %) was "Resuscitation is undertaken if neonatal adaptation is sufficient". During the 25th WG, several answers were given, but only 6 % chose "Resuscitation is never undertaken". CONCLUSION: Analyzing the survey's answers indicates that the decision of whether to resuscitate these premature infants at the threshold of viability must be adjusted not only by gestational age, but also by many other factors.

[Syncope and pre-syncope in children and adolescents: a prospective study in a pediatric emergency care unit]. / Syncopes et lipothymies chez l'enfant et l'adolescent : étude prospective dans une unité d'urgence pédiatrique.

OBJECTIVES: To assess in a pediatric emergency care unit (PECU): 1. The frequency of syncope and pre-syncope, 2. The incidence of diagnoses, 3. The value of investigations and cardiology and neurology consultations. METHODS: The data of PECU patients aged 2 years to 15 years and 3 months were prospectively collected over 1 year. Standard electrocardiogram and serum glucose were compulsory investigations. Schellong's orthostatic test was performed whenever possible. RESULTS: One hundred and fity-nine children (mean age, 11+/-4 years) were included, accounting for 0.8% of the PECU's visits: 48% had syncope, 52% had pre-syncope. The most common cause was neurally mediated syncope - 98 patients (62%), with vasovagal syncope for 80 patients - followed by neurological causes: 29 patients (18%). Neither cardiac arrhythmia nor obstructive cardiomyopathy was diagnosed. There were discrepancies between cardiologists' and pediatricians' ECG interpretations in 9% of cases. Diagnoses differed between cardiologists and pediatricians in 54% of 41 consultations. Diagnoses differed between neurologists and pediatricians in 54% of 42 consultations. No investigation except Schellong's orthostatic test led to modification of a previous diagnosis. CONCLUSION: This study emphasizes that the routine workup of pediatric syncope should focus on the patient's history and physical examination. Diagnostic testing should be minimal: ECG and Schellong's orthostatic test. The leading cause was neurocardiogenic syncope.

[Interfaces for pediatric noninvasive ventilation (excluding neonate)]. / Interfaces pour la ventilation non invasive de l'enfant (à l'exclusion du nouveau-né).

The quality of noninvasive ventilation in pediatrics is interface-dependent. Several types of interfaces are currently available: nasal and oral masks, nasal pillows and helmets. Despite material improvements in material design, shape, size and components, interfaces are still not adapted for most children. The ideal interface must fit the child's characteristics and the disease requirements. For instance, a nasal canula is recommended for infants younger than 3 months of age. If necessary, nasal masks can be used as oronasal masks. Repeated and careful evaluations are indicated to ensure interface adequacy and to detect cutaneous injuries and facial deformities. Training is required for medical and paramedical personnel. Pediatrics studies, comparing interfaces, are needed to build evidence-based recommendations.