Parental presence during pediatric retrieval: the caregiver's perspective.

The presence of family at the bedside of critically ill children is recommended, as part of "family-centered care." The study aimed to understand if such recommendation was applied by our neonatal and pediatric retrieval team and the second aim was their perception of parental presence. We first conducted a 6-month monocentric prospective observational study where the transport teams had to rate parental presence after each retrieval. A second survey was filled out by all team members, to explore their perception of parental presence in a general manner, without referring to a specific transport. Three hundred seventeen questionnaires from the prospective survey were returned, with parents being present in the ambulance for 47% of retrievals. There was a significant difference in parental accompaniment between newborns (< 24 h) and older children. The parental presence was rated as neutral or positive for 99% of transportation, whereas approximately » of the crew feared "a priori" parental presence during transport in the second survey.Conclusion: This study suggests at least one parent was present at almost half of the retrievals conducted in our sample during the study period. Very few negative experiences were reported in the prospective study by the caregivers who allowed parental presence. What is Known: •The concept of family-centered care is an approach that recognizes the importance of family engagement and involvement and encourages collaboration between families and healthcare professionals. •Parents wish to accompany their child. What is New: •The perception of parental presence, by transport team members, was neutral or positive in 99% of retrievals during the study. •Newborns' parents were less present during retrieval than older children's parents.

Premedication practices for tracheal intubation in neonates transported by French medical transport teams: a prospective observational study.

OBJECTIVES: Premedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France. SETTING: This prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation. PARTICIPANTS: 40 neonates intubated in 28 different centres. RESULTS: The mean (SD) age was 34.9 (3.9) weeks, and 62.5% were intubated in the delivery room. 30/40 (75%) of intubations were performed with the use of SA. In 18/30 (60.0%) intubations performed with SA, the drug regimen was the association of sufentanil and midazolam. Atropine was given in 19/40 intubations. From the 16, 21 and 3 intubations classified as emergent, semiemergent and non-emergent, respectively, 8 (50%), 19 (90.5%) and 3 (100%) were performed with SA premedication. 79.3% of intubations performed with SA had TRACHEA scores of 3 or less. 22/40 (55%) infants had at least one of the following adverse events: muscle rigidity, bradycardia below 100/min, desaturation below 80% and nose or pharynx-larynx bleeding. 7/24 (29.2%) of those who had only one attempt presented at least one of these adverse events compared with 15/16 (93.8%) of those who needed two or more attempts (p<0.001). CONCLUSION: SA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or semiemergent. TRIAL REGISTRATION NUMBER: NCT01346813; Results.